Trends in Problems Related to Extramedical Use of Analgesics

描述（由研究者提供）：尽管人们越来越关注由于滥用镇痛药物而导致的日益严重的滥用/依赖问题，但在美国，人们对这一公共卫生问题的性质和程度知之甚少。在过去的十年中，药物外镇痛的开始一直在上升，但镇痛使用者的特征以及与药物外镇痛使用和滥用/依赖相关的潜在途径仍未得到充分研究。本研究的目的是：1)检验药物外镇痛药使用者特征随时间的变化，2)检验精神疾病与药物外镇痛药使用和滥用/依赖之间的潜在因果途径，3)估计药物外镇痛药滥用/依赖症状在美国家庭人口中的分布，4)基于观察到的镇痛药物滥用/依赖症状聚类，检验医外镇痛药物使用问题的类别，并确定与镇痛药物滥用/依赖相关的因素。我们使用了美国两项主要的药物使用和相关问题调查的数据：国家药物使用和健康调查（NSDUH）和国家酒精中毒及相关疾病流行病学调查（NESARC）。在初步的探索性数据分析后，我们将使用逻辑回归来估计医疗外镇痛药使用与人口统计学特征、精神合并症和其他药物使用模式的关联，并测试这些关联是否随时间而改变。我们将估计药物外镇痛药滥用/依赖的流行程度，并测试药物外镇痛药使用者滥用/依赖的条件概率是否随时间而变化。我们将使用带有时间相关协变量的Cox比例风险模型来检验精神疾病与医疗外镇痛药使用、滥用和依赖之间的潜在因果途径。此外，我们将估计总体人群中疾病和个体症状的发生率和流行率，并使用广义估计方程来比较药物外镇痛药使用者亚组之间以及当前和过去药物外镇痛药使用者之间滥用/依赖症状的概况。我们将使用潜在类别分析来测试使用止痛药滥用/依赖症状的最佳拟合潜在类别模型，并将这些类别与现有的诊断类别进行比较，我们将通过药物使用亚组来测试潜在类别结构的变化-例如，比较不使用其他阿片类药物的止痛药使用者与使用海洛因的人的潜在类别结构。潜在类别回归将用于调查类别成员如何随感兴趣的特征（例如，人口统计学特征）而变化。最后，我们相信我们的研究将带来重大的公共卫生贡献，以帮助制定预防和治疗策略，以减少医疗外镇痛药的使用，滥用和依赖。拟议的研究将有助于了解与医疗外镇痛药使用有关的潜在问题，以及精神疾病与医疗外镇痛药使用之间的因果途径。这将有助于预防、干预和治疗问题的医疗外止痛药使用者的发展。

DESCRIPTION (provided by investigator): Despite increasing concern about the growing problem of abuse/dependence due to misuse of analgesic medications, little is known about the nature and extent of this public health problem in the United States. Extramedical analgesic initiation has been on the rise during the past decade, but the characteristics of analgesic users as well as the potential pathways associated with extramedical analgesic use and abuse/dependence are still understudied. The objectives of this study are to : 1) test for changes in characteristics of extramedical analgesic users over time, 2) test for potential causal pathways between psychiatric disorders and extramedical analgesic use and abuse/dependence, 3) estimate the distribution of symptoms of extramedical analgesic abuse/dependence in the U.S. household population, 4) test for categories of problem extramedical analgesic use based on observed clustering of symptoms of analgesic abuse/dependence and identify factors associated with analgesic abuse/dependence. We use data from two major surveys of drug use and related problems in the U.S: the National Survey on Drug Use and Health (NSDUH), and the National Epidemiologic Survey on Alcoholism and Related Conditions (NESARC). After initial exploratory data analyses, we will use logistic regression to estimate associations of extramedical analgesic use with demographic characteristics, psychiatric comorbidity and patterns of other drug use and to test whether these associations change over time. We will estimate the prevalence of extramedical analgesic abuse/dependence over time and test whether the conditional probability of abuse/dependence among extramedical analgesic users has changed over time. We will use Cox proportional hazards models with time- dependent covariates to test for potential causal pathways between psychiatric disorders and extramedical analgesic use, abuse and dependence. In addition, we will estimate incidence and prevalence of disorders and individual symptoms overall in the population and use generalized estimating equations to compare profiles of symptoms of abuse/dependence across subgroups of extramedical analgesic users and between current and past extramedical analgesic users. We will use latent class analysis to test for the best fitting latent class model using the symptoms of analgesic abuse/dependence and compare these classes to existing diagnostic categories, and we will test for variation in latent class structure by subgroups of drug use - e.g., compare latent class structure for analgesic users without other opiate use versus those with heroin use. Latent class regression will be used to investigate how class membership varies in relation to characteristics of interest (e.g., demographic characteristics). Finally, we believe that our study will bring significant public health contributions to help develop prevention and treatment strategies in order to decrease extramedical analgesic use, abuse and dependence. The proposed research will shed light in the understanding of potential problems related to extramedical analgesic use and of causal pathways between psychiatric disorders and extramedical analgesic use. It will contribute to the development of prevention, intervention and treatment for problem extramedical analgesic users.