Edlund Mark J, Steffick Diane, Hudson Teresa, Harris Katherine M, Sullivan Mark
Central Arkansas Veterans Healthcare System, USA University of Arkansas for Medical Sciences, USA Arbor Research Collaborative for Health, USA RAND Corporation, USA University of Washington, USA.
Pain. 2007 Jun;129(3):355-362. doi: 10.1016/j.pain.2007.02.014. Epub 2007 Apr 20.
A central question in prescribing opioids for chronic non-cancer pain (CNCP) is how to best balance the risk of opioid abuse and dependence with the benefits of pain relief. To achieve this balance, clinicians need an understanding of the risk factors for opioid abuse, an issue that is only partially understood. We conducted a secondary data analysis of regional VA longitudinal administrative data (years 2000-2005) for chronic users of opioids for CNCP (n=15,160) to investigate risk factors for the development of clinically recognized (i.e., diagnosed) opioid abuse or dependence among these individuals. We analyzed four broad groups of possible risk factors: (i) non-opioid substance abuse disorders, (ii) painful physical health disorders, (iii) mental health disorders, and (iv) socio-demographic factors. In adjusted models, a diagnosis of non-opioid substance abuse was the strongest predictor of opioid abuse/dependence (OR=2.34, p<0.001). Mental health disorders were moderately strong predictors (OR=1.46, p=0.005) of opioid abuse/dependence. However, the prevalence of mental health disorders was much higher than the prevalence of non-opioid substance abuse disorders (45.3% vs. 7.6%) among users of opioids for CNCP, suggesting that mental health disorders account for more of the population attributable risk for opioid abuse than does non-opioid substance abuse. Males, younger adults, and individuals with greater days supply of prescription opioids dispensed in 2002 were more likely to develop opioid abuse/dependence. Clinicians need to carefully screen for substance abuse and mental health disorders in candidates for opioid therapy and facilitate appropriate treatment of these disorders.
在为慢性非癌性疼痛（CNCP）开具阿片类药物时，一个核心问题是如何在阿片类药物滥用和依赖风险与疼痛缓解益处之间实现最佳平衡。为了实现这种平衡，临床医生需要了解阿片类药物滥用的风险因素，而这一问题目前仅得到部分理解。我们对区域退伍军人事务部（VA）2000 - 2005年期间慢性非癌性疼痛阿片类药物长期使用者（n = 15,160）的纵向管理数据进行了二次数据分析，以调查这些个体中临床认可（即诊断）的阿片类药物滥用或依赖发展的风险因素。我们分析了四大类可能的风险因素：（i）非阿片类物质滥用障碍，（ii）疼痛性身体健康障碍，（iii）精神健康障碍，以及（iv）社会人口统计学因素。在调整模型中，非阿片类物质滥用诊断是阿片类药物滥用/依赖的最强预测因素（OR = 2.34，p < 0.001）。精神健康障碍是阿片类药物滥用/依赖的中度强预测因素（OR = 1.46，p = 0.005）。然而，在慢性非癌性疼痛阿片类药物使用者中，精神健康障碍的患病率远高于非阿片类物质滥用障碍的患病率（45.3%对7.6%），这表明精神健康障碍比非阿片类物质滥用在阿片类药物滥用的人群归因风险中占比更大。男性、年轻人以及2002年处方阿片类药物供应天数更多的个体更有可能发展为阿片类药物滥用/依赖。临床医生在阿片类药物治疗候选人中需要仔细筛查物质滥用和精神健康障碍，并促进对这些障碍的适当治疗。
