University of Manitoba, Department of Psychiatry, Winnipeg, Manitoba, Canada.
Drug Alcohol Depend. 2013 Sep 1;132(1-2):107-13. doi: 10.1016/j.drugalcdep.2013.01.010. Epub 2013 Feb 9.
There has been a significant increase in opioid prescriptions and the prevalence of opioid nonmedical use. Nonmedical use may lead to opioid abuse/dependence, a serious public health concern. The aim of this paper was to determine the mental and physical health predictors of incident nonmedical prescription opioid use (NMPOU) and abuse/dependence, and the impact of comorbidity in a longitudinal, nationally representative sample.
Data come from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N=34,653; ≥20 years old). Mental disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV edition. Physical conditions were based on self-reports of physician-diagnoses. Multiple logistic regression models examined the associations between mental and physical health predictors at Wave 1 and their association to incident NMPOU and abuse/dependence disorders at Wave 2.
After adjusting for sociodemographics, Axis I and II mental disorders and physical conditions, the presence of mental disorders (i.e., mood, personality disorders and substance use disorders), physical conditions (i.e., increasing number of physical conditions, any physical condition, arteriosclerosis or hypertension, cardiovascular disease and arthritis) and sociodemographic factors (i.e., sex and marital status) at Wave 1 positively predicted incident abuse/dependence at Wave 2. Comorbid disorders increased the risk of NMPOU and abuse/dependence.
These results suggest the importance of mental and physical comorbidity as a risk for NMPOU and abuse/dependence, emphasizing the need for careful screening practices when prescribing opioids.
阿片类药物处方和非医疗使用的流行率显著增加。非医疗使用可能导致阿片类药物滥用/依赖，这是一个严重的公共卫生问题。本文的目的是确定在纵向、全国代表性样本中，非医疗处方阿片类药物使用（NMPOU）和滥用/依赖的发生的精神和身体健康预测因素，以及共病的影响。
数据来自国家酒精和相关条件流行病学调查的第 1 波和第 2 波（N=34653；年龄≥20 岁）。使用酒精使用障碍和相关障碍访谈表 DSM-IV 版评估精神障碍。身体状况基于医生诊断的自我报告。多变量逻辑回归模型检验了第 1 波时精神和身体健康预测因素与第 2 波时发生的 NMPOU 和滥用/依赖障碍之间的关联。
在调整了社会人口统计学、轴 I 和 II 精神障碍和身体状况后，第 1 波时存在精神障碍（即情绪、人格障碍和物质使用障碍）、身体状况（即身体状况增加、任何身体状况、动脉硬化或高血压、心血管疾病和关节炎）以及社会人口统计学因素（即性别和婚姻状况）与第 2 波时发生的滥用/依赖障碍呈正相关。共病增加了 NMPOU 和滥用/依赖的风险。
这些结果表明，精神和身体共病是 NMPOU 和滥用/依赖的一个重要风险因素，强调在开具阿片类药物时需要谨慎进行筛查。
