Pain Medication Prescriptions and Misuse Following Treatment for Alcohol Use Disorders

摘要 酒精使用障碍（AUD）和疼痛之间存在重要联系，这些联系在很大程度上被忽视，直到 最近例如，酒精依赖者经常因意外事故而受到身体伤害 和暴力会对身体造成持久的影响长期饮酒也会导致身体状况， 产生明显的疼痛。同样，AUD也可能导致对疾病医疗方案的依从性差 这会导致疼痛加剧。最后，鉴于普通神经回路受到慢性 疼痛和酒精依赖，酒精依赖可能导致疼痛感增强， 疼痛可能导致酒精的止痛作用。考虑到AUD和慢性 疼痛，这并不奇怪，发现显著比例的个人与AUD报告，他们的经验， 严重疼痛，正在治疗慢性疼痛。慢性疼痛的存在与个人 AUD，加上酒精使用障碍的慢性复发性，增加了个体 患有酒精使用障碍的患者可能会寻求慢性疼痛治疗，接受阿片类药物和/或苯二氮卓类药物 疼痛处方，并有与使用这些药物相关的发病率和死亡率风险， 特别是在过量饮酒的情况下。本研究建议整合客户的记录 纽约州酗酒和药物滥用服务办公室（OASAS）患者数据系统 与纽约州医疗补助记录。我们计划确定大约214，000名医疗补助患者 2006-2014年首次接触OASAS治疗系统，并将这些治疗记录 他们的医疗补助索赔记录，从他们最初的治疗接触到2015年。此外，我们将绘制一个 从Medicaid索赔中抽取三倍大的匹配个体作为比较样本。 假设将解决有酒精问题治疗史的个人在多大程度上 接受阿片类药物和苯二氮卓类药物处方治疗疼痛的风险增加，以及这是否是因为 疼痛诊断的风险增加，或者在控制诊断后这种风险是否仍然存在。我们还将 确定酒精治疗患者是否有更高剂量、更长持续时间的进一步风险， 这些物质的滥用/过量，以及疼痛诊断是否说明了这种风险。而且 这些数据集的整合将使我们能够识别现有治疗记录中的因素， 最有可能过度使用和滥用这些药物的人。这些发现将 对于在初级保健中管理具有未被识别的病史的患者的重要临床意义 酒精使用障碍和政策影响方面的医疗访问酒精治疗记录。

Abstract There are critical links between alcohol use disorder (AUD) and pain that have been largely ignored until recently. For example, individuals with alcohol dependence often experience physical injuries from accidents and violence that have a lasting physical impact. Chronic alcohol use can also lead to physical conditions that produce significant pain. Similarly, AUDs can also lead to poor adherence to medical regimens for diseases which can result in exacerbation in pain. Finally, given that common neural circuits are impacted by chronic pain and by alcohol dependence, alcohol dependence may lead to heightened feelings of pain, and that such pain may lead to alcohol use for its analgesic properties. Given these linkages between AUDs and chronic pain, it is not surprising to find significant proportions of individuals with AUD report that they experience significant pain and are in treatment for chronic pain. The presence of chronic pain among individuals with AUD, combined with the chronic, relapsing nature of alcohol use disorders raises the possibility that individuals with an alcohol use disorder may seek treatment for chronic pain, receive opioid and/or benzodiazepine prescriptions for pain, and be at risk for morbidity and mortality associated with using these medications, particularly in conjunction with excessive alcohol use. This study proposes to integrate records from the Client Data System of the New York State Office of Alcoholism and Substance Abuse Services (OASAS) patient records with New York State Medicaid records. We plan to identify approximately 214,000 Medicaid patients with a first contact with the OASAS treatment system from 2006-2014 and merge these treatment records with their Medicaid claims records from their initial treatment contact through 2015. In addition, we will draw a sample three times as large of matched individuals from the Medicaid claims to serve as a comparison sample. Hypotheses will address the extent to which individuals with a history of treatment for alcohol problems are at increased risk for receiving prescriptions for opioids and benzodiazepine for pain and whether this is because of an increased risk of pain diagnoses, or whether this risk remains after controlling for diagnoses. We will also determine if alcohol treatment patients are at further risk for higher doses, longer durations, and misuse/overdose from these substances, and whether pain diagnoses account for this risk. Moreover, the integration of these datasets will allow us to identify factors in the existing treatment records that would identify individuals most at risk for the excessive use and misuse of these medications. These findings will have important clinical implications for the management of patients in primary care with an unrecognized history of an alcohol use disorder and policy implications with respect to medical access to alcohol treatment records.