Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, 06516, USA.
AIDS Behav. 2019 Dec;23(12):3340-3349. doi: 10.1007/s10461-019-02608-3.
A better understanding of predisposition to transition to high-dose, long-term opioid therapy after initial opioid receipt could facilitate efforts to prevent opioid use disorder (OUD). We extracted data on 69,268 patients in the Veterans Aging Cohort Study who received any opioid prescription between 1998 and 2015. Using latent growth mixture modelling, we identified four distinguishable dose trajectories: low (53%), moderate (29%), escalating (13%), and rapidly escalating (5%). Compared to low dose trajectory, those in the rapidly escalating dose trajectory were proportionately more European-American (59% rapidly escalating vs. 38% low); had a higher prevalence of HIV (31% vs. 29%) and hepatitis C (18% vs. 12%); and during follow-up, had a higher incidence of OUD diagnoses (13% vs. 3%); were hospitalised more often [18.1/100 person-years (PYs) vs. 12.5/100 PY]; and had higher all-cause mortality (4.7/100 PY vs. 1.8/100 PY, all p < 0.0001). These measures can potentially be used in future prevention research, including genetic discovery.
更好地了解初始接受阿片类药物治疗后向高剂量、长期阿片类药物治疗转变的倾向，可以促进预防阿片类药物使用障碍（OUD）的努力。我们从 1998 年至 2015 年期间接受过任何阿片类药物处方的退伍军人衰老队列研究中提取了 69268 名患者的数据。使用潜在增长混合模型，我们确定了四个可区分的剂量轨迹：低（53%）、中（29%）、递增（13%）和快速递增（5%）。与低剂量轨迹相比，快速递增剂量轨迹的患者中欧洲裔美国人的比例更高（59%快速递增 vs. 38%低剂量）；艾滋病毒（31% vs. 29%）和丙型肝炎（18% vs. 12%）的患病率更高；在随访期间，OUD 诊断的发生率更高（13% vs. 3%）；住院治疗的频率更高[18.1/100 人年（PYs）vs. 12.5/100 PY]；全因死亡率更高（4.7/100 PY vs. 1.8/100 PY，所有 p 值均<0.0001）。这些措施可能在未来的预防研究中得到应用，包括基因发现。
