Castaldelli-Maia João Mauricio, Andrade Laura H, Keyes Katherine M, Cerdá Magdalena, Pilowsky Daniel J, Martins Silvia S
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, 05403, Brazil; Interdisciplinary Group of Studies on Alcohol and Drugs, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, 05403, Brazil; Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP, 09060, Brazil.
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, 05403, Brazil.
J Psychiatr Res. 2016 Sep;80:79-86. doi: 10.1016/j.jpsychires.2016.05.007. Epub 2016 May 24.
There is a need to explore the dimensional and categorical phenotypes of criteria of opioid use disorder among frequent nonmedical users of prescription opioids (NMUPO) users.
We used pooled data of 2011-2012 National Survey on Drug Use and Health to examine reliability and phenotypic variability in the diagnosis of OUD secondary to NMUPO in a nationally-representative sample of 18+ years-old frequent past-year NMUPO users (120+ days, n = 806). Through exploratory factor analysis (EFA) and latent class analysis (LCA), we examined 10 past-year OUD criteria. We examined associations between the latent classes and sociodemographic/psychiatric/NMUPO correlates.
OUD criteria were unidimensional, and a three-class model was the overall best fitting solution for characterizing individuals into phenotypes along this unidimensional continuum: a "non-symptomatic class" (40.7%), "Tolerance-Time spent class" (29.0%) with high probability of endorsing Tolerance/Time Spent criteria, and a "High-moderate symptomatic class" (30.1%). The last class was significantly associated with being male, having insurance and obtaining prescription opioids (PO) nonmedically via "doctor shopping" as compared to the non-symptomatic class. "Tolerance-Time spent class" was significantly associated with being younger (18-25 years) and obtaining PO nonmedically from family/friends as compared to the non-symptomatic class.
This study revealed the different characteristics and routes of access to PO of different classes of frequent NMUPO users. It is possible that these groups may respond to different interventions, however such conclusions would require a clinical study.
有必要探索处方阿片类药物频繁非医疗使用者（NMUPO）中阿片类药物使用障碍标准的维度和分类表型。
我们使用2011 - 2012年全国药物使用和健康调查的汇总数据，在一个全国代表性的18岁及以上过去一年频繁NMUPO使用者（120天以上，n = 806）样本中，检查因NMUPO导致的阿片类药物使用障碍（OUD）诊断的可靠性和表型变异性。通过探索性因素分析（EFA）和潜在类别分析（LCA），我们检查了10个过去一年的OUD标准。我们检查了潜在类别与社会人口统计学/精神病学/NMUPO相关因素之间的关联。
OUD标准是单维的，一个三类模型是将个体沿此单维连续体表征为表型的总体最佳拟合解决方案：一个“无症状类别”（40.7%）、“耐受性 - 花费时间类别”（29.0%），其认可耐受性/花费时间标准的可能性很高，以及一个“中重度症状类别”（30.1%）。与无症状类别相比，最后一个类别与男性、有保险以及通过“医生购物”非医疗获取处方阿片类药物（PO）显著相关。与无症状类别相比，“耐受性 - 花费时间类别”与更年轻（18 - 25岁）以及从家人/朋友处非医疗获取PO显著相关。
本研究揭示了不同类别的频繁NMUPO使用者获取PO的不同特征和途径。这些群体可能对不同的干预措施有不同反应，然而这样的结论需要临床研究来证实。
