Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Aliment Pharmacol Ther. 2018 Mar;47(6):784-791. doi: 10.1111/apt.14503. Epub 2018 Jan 12.
While opioid prescriptions have increased alarmingly in the United States (US), their use for unexplained chronic gastrointestinal (GI) pain (eg, irritable bowel syndrome) carries an especially high risk for adverse effects and questionable benefit.
To compare opioid use among US veterans with structural GI diagnoses (SGID) and those with unexplained GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have no accepted role.
Veterans Health Administration (VHA) administrative data from fiscal year 2012 were used to identify veterans with diagnostic codes recorded for SGID and FGID. This cohort study examined VHA pharmacy data to compare groups receiving ≥ 1 opioid prescription during the year and number of prescriptions filled. Bivariate and multiple logistic regression analyses adjusted for potential confounding factors (demographics, medical diagnoses, social factors) and identified potential mediators (service use, psychiatric comorbidity) of opioid use in these groups.
A greater proportion of veterans with FGID received an opioid prescription during fiscal year 2012 (36.0% of 272 431) compared to only 28.9% of 1 223 744 in the SGID group (Relative Risk [RR] = 1.25). In multivariate logistic regression, personality disorders and drug abuse (OR 1.23 for each group), recent homelessness (OR 1.22), psychotropic medication fills (OR 1.55) and emergency department encounters (OR 1.21) were independently associated with opioid prescription use.
Despite the potential for adverse consequences, opioids more often are prescribed for veterans with chronic, unexplained GI symptoms compared to those with structural diagnoses. Psychiatric comorbidities and frequent healthcare encounters mediate some of the opioid use risk.
在美国，阿片类药物处方数量惊人地增加，而将其用于不明原因的慢性胃肠道（GI）疼痛（例如肠易激综合征）会带来特别高的不良反应和可疑益处风险。
比较美国退伍军人中患有结构性胃肠道（GI）疾病（SGID）和患有不明原因的胃肠道症状或功能性胃肠道疾病（FGID）的退伍军人的阿片类药物使用情况，对于后一组患者，阿片类药物没有被认可的作用。
使用退伍军人健康管理局（VA）2012 财年的行政数据，确定有 SGID 和 FGID 诊断代码记录的退伍军人。本队列研究检查了 VA 药房数据，以比较当年接受≥1 个阿片类药物处方的组和填写的处方数量。双变量和多变量逻辑回归分析调整了潜在混杂因素（人口统计学、医疗诊断、社会因素），并确定了这些组中阿片类药物使用的潜在中介因素（服务使用、精神共病）。
与 SGID 组（28.9%）相比，2012 财年 FGID 退伍军人接受阿片类药物处方的比例更高（272431 人中的 36.0%，相对风险[RR]为 1.25）。在多变量逻辑回归中，人格障碍和药物滥用（每组 OR 1.23）、最近无家可归（OR 1.22）、精神药物配药（OR 1.55）和急诊就诊（OR 1.21）与阿片类药物处方使用独立相关。
尽管存在不良反应的潜在风险，但与结构性诊断相比，慢性、不明原因的胃肠道症状退伍军人更常被开出阿片类药物。精神共病和频繁的医疗保健接触部分解释了阿片类药物使用的风险。
