Opioid Misuse and Overdose Risk Patterns among Recent Veterans

最近退伍军人中阿片类药物滥用和过量的风险模式

• 批准号: 9251027
• 负责人: Alexander S Bennett
• 金额: $ 9.68万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9251027
• 关键词: Address; Afghanistan; Alcohol or Other Drugs use; Behavior; Behavioral; Biological; Cessation of life; Conflict (Psychology); Data; Dimensions; Employment Status; Ethnography; Event; Foundations; Future; Health; Home environment; Homelessness; Housing; Intervention; Interview; Iraq; Lead; Learning; Life; Literature; Mental Depression; Mental Health; Methods; Military Personnel; Minority; Occupations; Opioid; Overdose; Pain; Pain management; Pattern; Perception; Pharmaceutical Preparations; Physiological; Post-Traumatic Stress Disorders; Research; Risk; Risk Behaviors; Severities; Social support; Surveys; Symptoms; Technology; Testing; Time; Veterans; Voice; Vulnerable Populations; Woman; base; biopsychosocial; combat; depressive symptoms; design; experience; insight; instrument; opioid misuse; opioid use; outcome prediction; prescription opioid; prescription opioid misuse; prevent; programs; psychologic; psychosocial; response; social; stressor; substance misuse

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.

描述（由申请人提供）：最近从伊拉克和阿富汗战场返回家园的退伍军人是一个弱势群体，面临处方阿片类药物（PO）滥用和过量的风险不成比例。正如目前的研究所表明的那样，这些风险对于妇女，少数民族，无家可归者和其他社会孤立的退伍军人以及那些有心理健康问题的人来说可能更高。尽管有这些关于特定退伍军人亚群中阿片类药物相关风险聚集的初步发现，但目前对这些风险如何随着时间的推移而出现以及什么条件和事件促使它们出现知之甚少。该项目是首批解决阿片类药物相关风险行为随时间推移而出现的问题，并跟踪退伍军人重返社会经历的变化维度，这些变化影响PO和其他物质使用模式。因此，这项研究将跟踪阿片类药物使用退伍军人的物质使用模式以及他们生活的其他生理，心理和社会方面，从创伤后应激障碍（PTSD）症状，抑郁症和疼痛严重程度到社会关系和就业状况。该研究将为吸毒过量风险行为出现之前的压力源、转折点和药物使用模式以及保护因素提供重要见解，这些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时保持安全。为此，它将调查以下目标：目标A：确定退伍军人中阿片类药物相关过量风险的关键背景因素。将对50名最近接受过处方阿片类药物治疗疼痛的退伍军人进行定性访谈，这些退伍军人至少经历过一次涉及阿片类药物的非致命性过量。获得的数据将阐明疼痛，阿片类药物，心理健康问题，生活压力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。目的B：确定与退伍军人随着时间的推移进入和退出过量风险有关的生物，心理和社会因素。该项目将调查250名最近使用PO的退伍军人，并跟踪他们两年，使用交互式语音应答（IVR）技术每月收集数据，以便：1）根据文献、异常PO使用的现有量表、已知过量风险和退伍军人中的常见风险，开发过量风险行为量表（ORBS（特别是目标A中确定的）;和2）关于过量风险行为的潜在生物心理社会（BPS）相关性的检验假设。目标C：确定退伍军人对过量风险随时间变化的主观看法，以及这些如何有助于阿片类药物使用模式变化的机制。对32名退伍军人的嵌入式子样本进行的持续定性访谈将为Aim B的发现提供重要补充，揭示退伍军人的主观感知，理解和误解，伴随着疼痛，心理健康和社会支持的变化，从而提供了过量风险变化的基础。

项目成果

Opioid-Involved Overdose Among Male Afghanistan/Iraq-Era U.S. Military Veterans: A Multidimensional Perspective.

• DOI: 10.1080/10826084.2017.1306563
• 发表时间: 2017-11-10
• 期刊: Substance use & misuse
• 影响因子: 2
• 作者: Bennett AS;Elliott L;Golub A;Wolfson-Stofko B;Guarino H
• 通讯作者: Guarino H

Recent Overdose Experiences in a Community Sample of Military Veterans Who Use Opioids.

最近使用阿片类药物的退伍军人社区样本的过量经历。

• DOI: 10.1177/0022042617701255
• 发表时间: 2017
• 期刊: Journal of drug issues
• 影响因子: 1.7
• 作者: Pouget,EnriqueR;Bennett,AlexS;Elliott,Luther;Rosenblum,Andrew;Britton,PeterC
• 通讯作者: Britton,PeterC

Opioid Use Initiation, Progression, and Motivations Among OEF/OIF/OND-Era Veterans in New York City: An Age-Period-Cohort Analysis.

纽约市 OEF/OIF/OND 时代退伍军人的阿片类药物使用起始、进展和动机：年龄-时期-队列分析。

• DOI: 10.1080/21635781.2017.1343163
• 发表时间: 2018
• 期刊: Military behavioral health
• 作者: Elliott,Luther;Golub,Andrew;Bennett,Alexander
• 通讯作者: Bennett,Alexander

A behavioral typology of opioid overdose risk behaviors among recent veterans in New York City.

• DOI: 10.1371/journal.pone.0179054
• 发表时间: 2017
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Bennett AS;Golub A;Elliott L
• 通讯作者: Elliott L

Drug use in business bathrooms: An exploratory study of manager encounters in New York City.

商务浴室中的药物使用：对纽约市经理遭遇的探索性研究。

• DOI: 10.1016/j.drugpo.2016.08.014
• 发表时间: 2017
• 期刊: The International journal on drug policy
• 作者: Wolfson-Stofko,Brett;Bennett,AlexS;Elliott,Luther;Curtis,Ric
• 通讯作者: Curtis,Ric