Opioid Misuse and Overdose Risk Patterns among Recent Veterans

描述(由申请人提供)：最近从伊拉克和阿富汗回国的退伍军人代表着弱势群体，他们面临着处方阿片类药物滥用和过量的不成比例的风险。目前的研究表明，对于女性、少数民族、无家可归者和其他与世隔绝的退伍军人以及那些有心理健康问题的人来说，这些风险可能更高。尽管有这些关于阿片类药物相关风险在特定退伍军人群体中聚集的初步发现，但目前对这些风险是如何随着时间的推移出现的以及是什么条件和事件导致这些风险知之甚少。该项目是首批解决阿片类药物相关危险行为随时间出现的问题，并跟踪影响PO和其他药物使用模式的退伍军人重返社会经历的变化方面的项目之一。因此，这项研究将跟踪使用阿片类药物的退伍军人的物质使用模式，以及他们生活的其他生理、心理和社会维度，从创伤后应激障碍(PTSD)症状、抑郁、疼痛严重程度到社会关系和就业状况。这项研究将为过量危险行为出现之前的压力源、转折点和药物使用模式提供关键的见解，以及保护因素，使一些使用阿片类药物的退伍军人在与疼痛和重返社会的心理社会挑战作斗争的情况下保持安全。为此，它将调查以下目标：目标A：确定退伍军人中与阿片类药物相关的过量风险的关键背景因素。将对50名最近接受阿片类药物止痛处方并至少经历过一次涉及阿片类药物的非致命过量的退伍军人进行定性访谈。所获得的数据将阐明疼痛、阿片类药物、心理健康问题、生活应激源和过量风险之间的关系。这些数据将为目标B和C的仪器设计和改进提供信息。目标B：确定与退伍军人随着时间的推移进入和退出过量风险相关的生物、心理和社会因素。该项目将调查250名新近使用PO的退伍军人，并对他们进行为期两年的跟踪调查，使用交互式语音应答(IVR)技术收集每月数据，以便：1)根据文献、异常使用PO的现有量表、已知的过量风险和退伍军人中的共同风险(特别是在Aim A中确定的)，制定过量药物风险行为量表(ORBS)；以及2)测试有关过量药物风险行为的潜在生物心理社会(BPS)相关性的假设。目标C：确定退伍军人对过量风险随时间的变化的主观看法，以及这些看法如何有助于阿片类药物使用模式变化的潜在机制。正在进行的对32名退伍军人的内嵌小样本的定性访谈将对AIM B的调查结果提供重要补充，揭示退伍军人在疼痛、心理健康和社会支持方面的变化带来的主观认知、理解和误解，从而为过量服药风险的变化奠定基础。

DESCRIPTION (provided by applicant): Veterans returning home from recent engagements in Iraq and Afghanistan represent a vulnerable population at disproportionate risk of prescription opioid (PO) misuse and overdose. As current research is demonstrating, these risks are potentially even higher for women, minority, homeless, and otherwise socially isolated veterans, as well as those with mental health concerns. Despite these preliminary findings about the clustering of opioid- related risks among particular veteran subpopulations, very little is currenty known about how these risks emerge over time and what conditions and events precipitate them. This project represents one of the first to address the emergence of opioid-related risk behaviors over time and to track the changing dimensions of veterans' reintegration experiences that impact PO and other substance use patterns. Accordingly, this study will track opioid-using veterans' substance use patterns alongside other physiological, psychological, and social dimensions of their lives, ranging from post-traumatic stress disorder (PTSD) symptoms, depression, and pain severity to social relationships and employment status. The study will provide critical insights into the stressors, turning points, and substance use patterns that precede emergence of overdose risk behaviors and the protective factors that keep some opioid-using veterans safe despite their struggles with pain and the psychosocial challenges of reintegration. To do so, it will investigate the following aims: Aim A: Identify key contextual dimensions of opioid-related overdose risk among veterans. Qualitative interviews will be administered to 50 recent veterans who have received prescription opioids for pain and who have experienced at least one non-fatal overdose involving opioids. The data obtained will illuminate the relationships among pain, opioid medications, mental health concerns, life stressors, and overdose risk. These data will inform instrument design and refinement for Aims B and C. Aim B: Identify biological, psychological and social factors related to veterans' transitions into and out of overdose risk over time. The project will survey 250 PO-using recent veterans and follow them for two years, collecting monthly data using interactive voice response (IVR) technology in order to: 1) Develop an Overdose Risk Behavior Scale (ORBS) based on the literature, existing scales for aberrant PO use, known overdose risks, and common risks among veterans (especially as identified in Aim A); and 2) Test hypotheses regarding potential biopsychosocial (BPS) correlates of overdose risk behavior. Aim C: Identify veterans' subjective perceptions of changes in overdose risk over time and how these contribute to the mechanisms underlying changes in opioid use patterns. Ongoing qualitative interviews with an embedded subsample of 32 veterans will provide an important supplement to the findings from Aim B, revealing veterans' subjective perceptions, understandings and misunderstandings that accompany changes in pain, mental health and social support, thus providing a foundation underlying changes in overdose risk.