VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A, West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States.
VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A, West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States.
Addict Behav. 2019 Feb;89:29-34. doi: 10.1016/j.addbeh.2018.09.010. Epub 2018 Sep 12.
Opioid use disorder (OUD) rates are high among veterans. PTSD is also prevalent among veterans; those with comorbidity have worse outcomes than those without comorbidity. This study assessed buprenorphine retention rates in veterans initiating OUD treatment, comparing veterans without PTSD to veterans with PTSD who were receiving versus not receiving concurrent trauma treatment.
This retrospective chart review examined consecutive referrals to buprenorphine maintenance (N = 140). PTSD diagnosis was identified by chart review and retention was defined as continuous buprenorphine maintenance 6-months post-admission. Logistic regression analyses compared buprenorphine retention for veterans without PTSD and PTSD-diagnosed veterans who received concurrent trauma treatment to a reference group of PTSD-diagnosed veterans who did not receive trauma treatment. Models adjusted for opioid type, age, and service-connected status.
Sixty-seven (47.9%) buprenorphine-seeking veterans carried a PTSD diagnosis; only 31.3% (n = 21) received trauma treatment while in buprenorphine maintenance, with 11.9% (n = 8) receiving evidence-based psychotherapy for PTSD. Among PTSD-diagnosed veterans who received trauma treatment, 90.5% (n = 19/21) were in buprenorphine maintenance at 6-months, compared to 23.9% (n = 11/46) of PTSD-diagnosed veterans without trauma treatment, and 46.6% (n = 34/73) of veterans without PTSD. In the full model, veterans with trauma treatment had 43.36 times greater odds of remaining in buprenorphine treatment than the reference group.
Most PTSD-diagnosed veterans in buprenorphine treatment were not receiving trauma treatment. Those receiving concurrent trauma treatment had better retention, suggesting OUD and trauma can be simultaneously addressed. Future clinical trials should investigate trauma-focused treatment for veterans with comorbid PTSD who are seeking buprenorphine for OUD.
退役军人中阿片类药物使用障碍（OUD）的发病率很高。退役军人中创伤后应激障碍（PTSD）也很普遍；患有合并症的患者比没有合并症的患者预后更差。本研究评估了开始 OUD 治疗的退役军人中丁丙诺啡的保留率，比较了没有 PTSD 的退役军人与同时接受或不接受创伤治疗的 PTSD 退役军人。
本回顾性图表审查研究了连续转诊至丁丙诺啡维持治疗的患者（N=140）。通过图表审查确定 PTSD 诊断，保留定义为入院后 6 个月内持续丁丙诺啡维持治疗。逻辑回归分析比较了无 PTSD 的退役军人和 PTSD 诊断退役军人中接受同时创伤治疗与未接受创伤治疗的 PTSD 诊断退役军人的丁丙诺啡保留率。模型调整了阿片类药物类型、年龄和与服务相关的地位。
67 名（47.9%）寻求丁丙诺啡治疗的退役军人携带 PTSD 诊断；只有 31.3%（n=21）在接受丁丙诺啡维持治疗的同时接受创伤治疗，其中 11.9%（n=8）接受 PTSD 的循证心理治疗。在接受创伤治疗的 PTSD 诊断患者中，90.5%（n=19/21）在 6 个月时仍在接受丁丙诺啡维持治疗，而未接受创伤治疗的 PTSD 诊断患者为 23.9%（n=11/46），无 PTSD 的退役军人为 46.6%（n=34/73）。在全模型中，接受创伤治疗的退伍军人继续接受丁丙诺啡治疗的可能性是参考组的 43.36 倍。
在接受丁丙诺啡治疗的 PTSD 诊断退役军人中，大多数未接受创伤治疗。同时接受创伤治疗的患者保留率更好，这表明 OUD 和创伤可以同时得到解决。未来的临床试验应研究针对同时患有 PTSD 的 OUD 寻求丁丙诺啡治疗的退役军人的创伤为重点的治疗方法。
