Trends in Problems Related to Extramedical Use of Analgesics

描述（由研究者提供）：尽管由于滥用镇痛药物而导致的滥用/依赖问题日益严重，但对美国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，医疗外镇痛剂的使用一直在上升，但镇痛剂使用者的特点以及与医疗外镇痛剂使用和滥用/依赖相关的潜在途径仍有待研究。本研究的目的是：1）测试医疗外镇痛药使用者的特征随时间的变化，2）测试精神疾病与医疗外镇痛药使用和滥用/依赖之间的潜在因果关系，3）估计美国家庭人口中医疗外镇痛药滥用/依赖症状的分布，4）基于观察到的镇痛剂滥用/依赖症状的聚类，测试问题医疗外镇痛剂使用的类别，并识别与镇痛剂滥用/依赖相关的因素。我们使用的数据来自美国两项主要的药物使用和相关问题调查：全国药物使用和健康调查（NSDUH）和全国酒精中毒和相关疾病流行病学调查（NESARC）。在初步探索性数据分析后，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、精神病合并症和其他药物使用模式的相关性，并测试这些相关性是否随时间而变化。我们将估计随着时间的推移，医疗外镇痛药滥用/依赖的患病率，并测试医疗外镇痛药使用者滥用/依赖的条件概率是否随着时间的推移而变化。我们将使用具有时间依赖性协变量的考克斯比例风险模型来检验精神疾病与医疗外镇痛剂使用、滥用和依赖之间的潜在因果关系。此外，我们将估计总体人群中疾病和个体症状的发生率和患病率，并使用广义估计方程比较医疗外镇痛药使用者亚组以及当前和既往医疗外镇痛药使用者之间的滥用/依赖症状特征。我们将使用潜在类别分析来测试使用镇痛剂滥用/依赖症状的最佳拟合潜在类别模型，并将这些类别与现有诊断类别进行比较，我们将测试药物使用亚组的潜在类别结构的变化-例如，比较没有使用其他阿片类药物的镇痛剂使用者与使用海洛因者的潜在类别结构。潜在类回归将用于研究类成员关系如何与感兴趣的特征（例如，人口特征）。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。拟议中的研究将阐明与医疗外镇痛药使用相关的潜在问题以及精神疾病和医疗外镇痛药使用之间的因果关系。这将有助于预防、干预和治疗有问题的医疗外止痛药使用者。

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.