Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
J Gen Intern Med. 2017 Oct;32(10):1076-1082. doi: 10.1007/s11606-017-4084-0. Epub 2017 Jun 9.
It is unclear whether substance use disorder (SUD) treatment is offered to, or utilized by, patients who are discontinued from long-term opioid therapy (LTOT) following aberrant urine drug tests (UDTs).
To describe the proportion of patients who were referred to, and engaged in, SUD treatment following LTOT discontinuation and to examine differences in SUD treatment referral and engagement based on the substances that led to discontinuation.
From a sample of 600 patients selected from a national cohort of Veterans Health Administration patients who were discontinued from LTOT, we used manual chart review to identify 169 patients who were discontinued because of a UDT that was positive for alcohol, cannabis, or other illicit or non-prescribed controlled substances.
We extracted sociodemographic, clinical, and health care utilization data from patients' electronic medical records.
Forty-three percent of patients (n = 73) received an SUD treatment referral following LTOT discontinuation and 20% (n = 34) engaged in a new episode of SUD treatment in the year following discontinuation. Logistic regression models controlling for sociodemographic and clinical variables demonstrated that patients who tested positive for cannabis were less likely than patients who tested positive for non-cannabis substances to receive referrals for SUD treatment (aOR = 0.44, 95% CI = 0.23-0.84, p = 0.01) or engage in SUD treatment (aOR = 0.42, 95% CI = 0.19-0.94, p = 0.04). Conversely, those who tested positive for cocaine were more likely to receive an SUD treatment referral (aOR = 3.32, 95% CI = 1.57-7.06, p = 0.002) and engage in SUD treatment (aOR = 2.44, 95% CI = 1.00-5.96, p = 0.05) compared to those who did not have a cocaine-positive UDT.
There may be substance-specific differences in clinician referrals to, and patient engagement in, SUD treatment. This suggests a need for more standardized implementation of clinical guidelines that recommend SUD care, when appropriate, following LTOT discontinuation.
目前尚不清楚在出现异常尿液药物检测（UDT）后停止长期阿片类药物治疗（LTOT）的患者中，是否为他们提供了物质使用障碍（SUD）治疗，或者他们是否接受了这种治疗。
描述 LTOT 停药后因 UDT 呈阳性而被转介接受 SUD 治疗和接受 SUD 治疗的患者比例，并根据导致停药的物质来检查 SUD 治疗转介和参与方面的差异。
从退伍军人事务部患者全国队列中选择的 600 名患者中抽取样本，我们通过手动图表审查，确定了 169 名因 UDT 呈阳性（酒精、大麻或其他非法或非处方管制物质）而停止 LTOT 的患者。
我们从患者的电子病历中提取社会人口统计学、临床和医疗保健利用数据。
43%的患者（n=73）在停止 LTOT 治疗后接受了 SUD 治疗转介，20%的患者（n=34）在停药后的一年内开始了新的 SUD 治疗。控制社会人口统计学和临床变量的逻辑回归模型显示，检测出大麻呈阳性的患者比检测出非大麻物质呈阳性的患者接受 SUD 治疗转介的可能性更低（比值比[aOR]=0.44，95%置信区间[CI]=0.23-0.84，p=0.01）或参与 SUD 治疗（aOR=0.42，95%CI=0.19-0.94，p=0.04）。相反，检测出可卡因呈阳性的患者更有可能接受 SUD 治疗转介（比值比[aOR]=3.32，95%CI=1.57-7.06，p=0.002）并接受 SUD 治疗（比值比[aOR]=2.44，95%CI=1.00-5.96，p=0.05），而不是那些没有可卡因阳性 UDT 的患者。
在临床医生转介和患者接受 SUD 治疗方面可能存在物质特异性差异。这表明需要更标准化地实施临床指南，在适当的情况下，在 LTOT 停药后提供 SUD 护理。
