Use and Abuse of Prescription Opioids Among OEF/OIF Veterans

描述（由申请人提供）：处方阿片类药物使用障碍（OUDs）是增长最快的药物滥用形式，处方阿片类药物现在是美国意外药物过量的最常见原因。超过一半的持久自由行动/伊拉克自由行动（OEF/OIF）退伍军人被诊断出患有疼痛症状，他们是阿片类药物治疗的潜在候选人，并且有这些OUDs的风险。2009年10月28日，退伍军人健康管理局（VHA）发布了一项疼痛管理指令，强调了与阿片类药物使用相关的风险，包括OUDs，并强制要求进行某些临床改变。新的VHA阿片类药物处方指南将于2009年底或2010年初发布。为了为退伍军人，特别是OEF/OIF退伍军人提供安全、高质量的CNCP护理，我们需要了解退伍军人特定问题、系统和提供者因素是否以及如何影响发生oud的可能性，并严格评估慢性阿片类药物使用、滥用和oud的趋势。目的1。使用单变量统计来描述四组退伍军人的临床和人口统计学特征：1)阿片类药物使用者，2)慢性使用者，3)具有阿片类药物滥用的慢性阿片类药物使用者，我们称之为“可能的阿片类药物滥用”，以及4)被诊断为药物滥用/依赖的个体。目标2。使用事件历史分析和多层次模型评估地理差异，并确定与以下因素相关的患者（社会人口统计学和临床）和治疗（临床环境）因素：a.任何阿片类药物使用的退伍军人中的慢性阿片类药物使用b.慢性阿片类药物使用的退伍军人中可能的阿片类药物滥用c.慢性阿片类药物使用的退伍军人中慢性阿片类药物使用的停止d.可能阿片类药物滥用的退伍军人和慢性阿片类药物使用的退伍军人中的OUD诊断。目标3。使用趋势分析，调查疼痛指导和指南发布前三年（08- 10财年）的慢性阿片类药物使用率、可能的滥用、慢性阿片类药物使用中断率和诊断的oud，以及指导和指南发布后的前整整三年（11-13财年）的使用率。方法：我们将利用6年VA管理数据（08- 13财年）的辅助数据分析，并对OEF/OIF退伍军人和所有退伍军人进行单独分析。

DESCRIPTION (provided by applicant): Prescription opioid use disorders (OUDs) are the fastest growing form of drug abuse and prescription opioids are now the most common cause of accidental drug overdose in the U.S. As more than half of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans have been diagnosed with a painful condition they are potential candidates for opioid therapy and are at risk for these OUDs. An October 28, 2009 Veterans Health Administration (VHA) pain management directive stressed the risks associated with opioid use, including OUDs, and mandated certain clinical changes. New VHA opioid prescribing guidelines will be released in late 2009 or early 2010. To provide safe, high-quality care for CNCP among veterans, particularly OEF/OIF veterans, we need to understand whether and how veteran-specific issues and system and provider factors affect likelihood of developing OUDs, and rigorously evaluate trends in chronic opioid use, misuse, and OUDs. Aim 1. Use univariate statistics to characterize clinical and demographic characteristics of four groups of veterans in VA care: 1) opioid users, 2) chronic users, 3) chronic opioid users with pharmacy profiles suggestive of opioid misuse, which we term "possible opioid misuse," and 4) individuals with diagnosed substance abuse/dependence. Aim 2. Use event history analysis and multi-level models to assess geographic variation and identify patient (sociodemographic and clinical) and treatment (clinical settings) factors associated with a. Chronic opioid use among veterans with any opioid use b. Possible opioid misuse among veterans with chronic opioid use c. Discontinuation of chronic opioid use, among veterans with chronic opioid use d. OUD diagnosis in veterans with possible opioid misuse, and in veterans with chronic opioid use. Aim 3. Use trend analyses to investigate rates of chronic opioid use, possible misuse, discontinuation of chronic opioid use, and diagnosed OUDs in the three years prior to the release of the pain directive and guidelines (FY08-FY10) with rates in the first full three years after the release of the directive and guidelines (FY11-13). Methods: We will utilize secondary data analysis of six years of VA administrative data (FY08-FY13), with separate analyses for OEF/OIF veterans and all veterans. PUBLIC HEALTH RELEVANCE: This study will allow us to better establish the extent of use and abuse of prescription opioids among veterans; identify risk factors for prescription opioid use disorders (OUDs); and assess temporal trends. This type of information is essential for clinicians, as they seek to minimize OUDs in their patients with pain.