阿片类药物戒断症状、频率和疼痛特征与注射吸毒者健康风险的相关性。
Opioid withdrawal symptoms, frequency, and pain characteristics as correlates of health risk among people who inject drugs.
机构信息
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, 90032 CA, United States of America.
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, 90032 CA, United States of America.
出版信息
Drug Alcohol Depend. 2020 Jun 1;211:107932. doi: 10.1016/j.drugalcdep.2020.107932. Epub 2020 Mar 18.
OBJECTIVE
Opioid withdrawal symptoms are widely understood to contribute to health risk but have rarely been measured in community samples of opioid using people who inject drugs (PWID).
METHODS
Using targeted sampling methods, 814 PWID who reported regular opioid use (at least 12 uses in the last 30 days) were recruited and interviewed about demographics, drug use, health risk, and withdrawal symptoms, frequency, and pain. Multivariable regression models were developed to examine factors associated with any opioid withdrawal, withdrawal frequency, pain severity, and two important health risks (receptive syringe sharing and non-fatal overdose).
RESULTS
Opioid withdrawal symptoms were reported by 85 % of participants in the last 6 months, with 29 % reporting at least monthly withdrawal symptoms and 35 % reporting at least weekly withdrawal symptoms. Very or extremely painful symptoms were reported by 57 %. In separate models, we found any opioid withdrawal (adjusted odds ratio [AOR] = 2.75, 95 % confidence interval [CI] = 1.52, 5.00) and weekly or more opioid withdrawal frequency (AOR = 1.94; 95 % CI = 1.26, 3.00) (as compared to less than monthly) to be independently associated with receptive syringe sharing while controlling for confounders. Any opioid withdrawal (AOR = 1.71; 95 % CI = 1.04, 2.81) was independently associated with nonfatal overdose while controlling for confounders. In a separate model, weekly or more withdrawal frequency (AOR = 1.69; 95 % CI = 1.12, 2.55) and extreme or very painful withdrawal symptoms (AOR = 1.53; 95 % CI = 1.08, 2.16) were associated with nonfatal overdose as well.
CONCLUSIONS
Withdrawal symptoms among PWID increase health risk. Treatment of withdrawal symptoms is urgently needed and should include buprenorphine dispensing.
目的
阿片类药物戒断症状被广泛认为会增加健康风险，但在社区注射吸毒者（PWID）的阿片类药物使用者样本中很少进行测量。
方法
使用目标抽样方法，招募了 814 名报告经常使用阿片类药物（过去 30 天内至少使用 12 次）的 PWID，并对他们进行了人口统计学、药物使用、健康风险和戒断症状、频率和疼痛的访谈。使用多变量回归模型来研究与任何阿片类药物戒断、戒断频率、疼痛严重程度以及两个重要健康风险（接受性注射器共享和非致命性过量）相关的因素。
结果
在过去的 6 个月中，85%的参与者报告了阿片类药物戒断症状，其中 29%报告了至少每月一次的戒断症状，35%报告了至少每周一次的戒断症状。57%的人报告了非常或极其疼痛的症状。在单独的模型中，我们发现任何阿片类药物戒断（调整后的优势比 [AOR] = 2.75，95%置信区间 [CI] = 1.52，5.00）和每周或更频繁的阿片类药物戒断频率（AOR = 1.94；95%CI = 1.26，3.00）（与每月不到一次相比）与接受性注射器共享独立相关，同时控制了混杂因素。任何阿片类药物戒断（AOR = 1.71；95%CI = 1.04，2.81）与非致命性过量独立相关，同时控制了混杂因素。在另一个模型中，每周或更频繁的戒断频率（AOR = 1.69；95%CI = 1.12，2.55）和极度或非常疼痛的戒断症状（AOR = 1.53；95%CI = 1.08，2.16）也与非致命性过量有关。
结论
PWID 中的戒断症状会增加健康风险。迫切需要治疗戒断症状，包括丁丙诺啡的配给。
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