Mason Michael J, Golladay Gregory, Jiranek William, Cameron Brian, Silverman Joel J, Zaharakis Nikola M, Plonski Paul
Department of Psychiatry (MJM, JJS, NZ, PP); Department of Orthopaedic Surgery (GG, WJ); and Department of Neurosurgery (BC), School of Medicine, Virginia Commonwealth University, Richmond, VA.
J Addict Med. 2016 Nov/Dec;10(6):408-413. doi: 10.1097/ADM.0000000000000253.
The nonmedical use of prescription medication among US adults is a growing public health problem. Healthcare providers should proactively address this problem in outpatient encounters.
We sought to understand the interactive effects among prescription drugs, pain, and psychiatric symptoms among adult outpatients to build an empirical foundation for comprehensive screening.
We screened 625 adult neurosurgery and orthopedic patients at a suburban satellite clinic of an urban academic medical center. A convenience sample was screened for psychiatric and substance use disorder symptoms using the American Psychiatric Association's recommended screening protocol. We tested whether psychiatric symptoms moderated the relationship between pain level and nonmedical use of prescription medicine.
Patients reported average levels of depression, anxiety, and pain symptoms, within 1 standard deviation of the screeners' normative data. However, patients reported highly elevated levels of nonmedical use of opioids and benzodiazapines compared with national data. Controlling for age, sex, and race, pain level predicted nonprescription use of opioid and benzodiazapine medications. Patients with high levels of depression and pain were more likely to engage in the unprescribed use of opioids. Likewise, patients with reduced levels of depression and pain were protected against the unprescribed use of opioids.
These findings highlight the importance of examining unprescribed medication use even with patients at moderate levels of psychiatric symptoms and pain.
美国成年人中处方药物的非医疗用途是一个日益严重的公共卫生问题。医疗保健提供者应在门诊就诊时积极解决这一问题。
我们试图了解成年门诊患者中处方药、疼痛和精神症状之间的相互作用，为全面筛查建立实证基础。
我们在一家城市学术医疗中心的郊区卫星诊所对625名成年神经外科和骨科患者进行了筛查。使用美国精神病学协会推荐的筛查方案对便利样本进行精神疾病和物质使用障碍症状筛查。我们测试了精神症状是否调节了疼痛水平与处方药物非医疗用途之间的关系。
患者报告的抑郁、焦虑和疼痛症状平均水平在筛查者规范数据的1个标准差范围内。然而，与全国数据相比，患者报告的阿片类药物和苯二氮卓类药物非医疗用途水平大幅升高。在控制年龄、性别和种族后，疼痛水平可预测阿片类药物和苯二氮卓类药物的非处方使用。抑郁和疼痛程度高的患者更有可能非处方使用阿片类药物。同样，抑郁和疼痛程度较低的患者可避免非处方使用阿片类药物。
这些发现凸显了即使是精神症状和疼痛程度中等的患者，检查非处方药物使用情况的重要性。
