Pain Medication Prescriptions and Misuse Following Treatment for Alcohol Use Disorders

酒精使用障碍治疗后的止痛药处方和滥用

基本信息

批准号：
10442656
负责人：
PETER L. ELKIN
金额：
$ 32.51万
依托单位：
STATE UNIVERSITY OF NEW YORK AT BUFFALO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10442656
关键词：
Accidents Acute Acute Pain Address Adherence Admission activity Adult Adverse event Age Alcohol abuse Alcohol consumption Alcohol dependence Alcoholism Alcohols Analgesics Benzodiazepines Cessation of life Chronic Client Clinical Data Data Set Databases Diagnosis Disease Dose Dropout Drug usage Exhibits Failure Family history of Feeling Goals Health Individual Information Systems Injury Lead Link Medicaid Medical Mental disorders Morbidity - disease rate Motivation Nature New York Opioid Overdose Pain Patients Pharmaceutical Preparations Pharmacotherapy Physicians Population Prevalence Primary Health Care Property Recording of previous events Records Regimen Relapse Reporting Risk Sampling Series Services Substance Use Disorder Substance abuse problem System Testing Time Treatment Factor Update Violence adverse outcome alcohol abuse therapy alcohol availability alcohol involvement alcohol use disorder chronic alcohol ingestion chronic pain chronic pain management drug misuse emotional abuse experience high risk misuse of prescription only drugs mortality neural circuit opioid misuse physical abuse policy implication prescription opioid prescription pain reliever problem drinker relapse prediction substance use treatment program treatment services

项目摘要

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.

抽象的酒精使用障碍（AUD）和疼痛之间存在关键联系，直到最近。例如，酒精依赖的人经常因事故而受到身体伤害和具有持久身体影响的暴力。慢性饮酒也会导致身体状况产生明显的疼痛。同样，AUDS也可能导致对疾病医疗方案的依从性不佳这会导致疼痛加剧。最后，鉴于常见的神经回路受到慢性影响疼痛和依赖酒精，酒精依赖可能会导致疼痛的增强，这样疼痛可能会导致其镇痛特性的饮酒。鉴于AUD和慢性之间的这些联系痛苦，发现大量有AUD报告的人会经历的毫不奇怪严重的疼痛，正在治疗慢性疼痛。患有患者的慢性疼痛的存在 aud结合慢性饮酒障碍的慢性复发性，使个人的可能性增加了使用饮酒障碍可能会寻求治疗慢性疼痛，接受阿片类药物和/或苯二氮卓类药物处方疼痛，有可能与使用这些药物相关的发病率和死亡率的风险，特别是与过量饮酒结合在一起。这项研究建议将客户的记录整合在一起纽约州酒精中毒和药物滥用服务（OASA）患者的数据系统带有纽约州医疗补助记录的记录。我们计划确定大约214,000名医疗补助患者从2006 - 2014年开始与OASA治疗系统首次接触，并将这些治疗记录合并他们的医疗补助索赔记录是从他们的初始治疗联系人到2015年的记录。此外，我们将绘制样本是Medicaid中的匹配个体的三倍，声称作为比较样本。假设将解决酒精问题治疗史的个人在多大程度上增加接受阿片类药物处方和苯二氮卓的处方的风险增加，是否是因为疼痛诊断的风险增加，或者在控制诊断后是否仍然存在这种风险。我们也会确定酒精治疗患者是否面临更高剂量，更长持续时间和这些物质的滥用/过量服用，以及疼痛是否诊断出这种风险。而且，这些数据集的集成将使我们能够确定现有治疗记录中的因素，以确定过度使用和滥用这些药物的人最有风险。这些发现将有对初级保健患者管理的重要临床意义酒精使用障碍和政策对酒精治疗记录的影响。