Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN (BRF, TNAW), Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN (GB, BG), University of Minnesota Medical School, Minneapolis, MN (RDS), Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN (TNAW).
J Addict Med. 2021 Apr 1;15(2):159-162. doi: 10.1097/ADM.0000000000000726.
To examine trends in polysubstance use among adults in treatment for opioid use disorder (OUD) and estimate associations between polysubstance use patterns and receipt of medications for OUD (MOUD).
We conducted a cross-sectional longitudinal analysis of treatment admissions for opioid use from 1992 to 2017 using the Treatment Episodes Data Set-Admissions (N = 9,440,157). We used multiple logistic regression to examine co-use patterns and estimate associations between receipt of MOUD and polysubstance use categories (opioid only, any methamphetamine, any cocaine, any alcohol, any benzodiazepine).
Between 1992 and 2017, treatment admissions involving opioid/cocaine (-17.2 percentage points [PP]) and opioid/alcohol co-use (-12.5 PP) decreased while opioid/methamphetamine (10.1 PP) and opioid/benzodiazepine co-use (5.6 PP) increased. In 2016 to 2017, receipt of medications for OUD was significantly higher for those who used opioids only (38.5%; 95% confidence interval [CI] 38.4-38.6) compared with individuals who used opioids with cocaine (35.7%; 95% CI 35.6-35.9), methamphetamine (23.9%; 95% CI 23.7-24.2), alcohol (25.0%; 95% CI 24.8-25.2), or benzodiazepines (34.6%; 95% CI 34.3-34.9). If those who co-used opioids with other substances received MOUD at the same rate as those who used opioids only, 47,400 additional people would have received MOUD between 2016 and 2017.
Opioid/methamphetamine and opioid/benzodiazepine increased substantially between 1992 and 2017. Co-use of other substances with opioids was associated with significantly lower receipt of MOUD. Treatment facilities should increase access to MOUD for individuals who co-use opioids with other substances. This change would extend evidence-based treatment to thousands of individuals and save lives.
研究接受阿片类药物使用障碍（OUD）治疗的成年人中多种物质使用的趋势，并估计多种物质使用模式与 OUD 药物治疗（MOUD）之间的关联。
我们使用治疗期间数据集中的入院资料（Treatment Episodes Data Set-Admissions，N=9440157），对 1992 年至 2017 年治疗阿片类药物使用的成人进行了一项横断面纵向分析。我们使用多项逻辑回归来研究共同使用模式，并估计 MOUD 与多种物质使用类别（仅阿片类药物、任何甲基苯丙胺、任何可卡因、任何酒精、任何苯二氮䓬类药物）之间的关联。
1992 年至 2017 年间，涉及阿片类药物/可卡因（-17.2%）和阿片类药物/酒精共同使用（-12.5%）的治疗入院率下降，而阿片类药物/甲基苯丙胺（10.1%）和阿片类药物/苯二氮䓬类药物共同使用（5.6%）增加。2016 年至 2017 年，仅使用阿片类药物的患者接受 OUD 药物治疗的比例明显更高（38.5%；95%置信区间[CI]38.4-38.6），而使用阿片类药物与可卡因（35.7%；95%CI35.6-35.9）、甲基苯丙胺（23.9%；95%CI23.7-24.2）、酒精（25.0%；95%CI24.8-25.2）或苯二氮䓬类药物（34.6%；95%CI34.3-34.9）的患者接受 MOUD 的比例较低。如果那些与其他物质共同使用阿片类药物的患者接受 MOUD 的比例与仅使用阿片类药物的患者相同，那么 2016 年至 2017 年期间将有 47400 人额外接受 MOUD。
1992 年至 2017 年间，阿片类药物/甲基苯丙胺和阿片类药物/苯二氮䓬类药物的使用大幅增加。与其他物质共同使用阿片类药物与接受 MOUD 的比例显著降低相关。治疗机构应增加对与其他物质共同使用阿片类药物的患者的 MOUD 治疗机会。这一变化将为数以千计的人提供循证治疗，并挽救生命。
