Ahonle Zaccheus J, Jia Huanguang, Mudra Stephen A, Romero Sergio, Castaneda Gail, Levy Charles
is a Research Assistant, is a Research Health Scientist, is a Health Science Specialist, , all at Veterans Rural Health Resource Center in Gainesville, Florida. is the Chief of Primary Care, Pain Management, and is the Chief of Physical Medicine and Rehabilitation, both at Gainesville VA Medical Center. Zaccheus Ahonle is an Assistant Professor in the Department of Counseling, Educational Psychology & Foundations at Mississippi State University, and Sergio Romero is a Research Assistant Professor, at the University of Florida in Gainesville.
Fed Pract. 2020 Sep;37(9):420-425. doi: 10.12788/fp.0025.
Suicide is the 10th leading cause of death in the US, primarily from drug overdose. In 2017, 67.8% of drug overdoses were with prescription opioids. The rate of opioid use disorder among patients in the Veterans Health Administration (VHA) is 7 times higher than that of non-VHA enrollees. This study compares the incidence of overdose and suicide across facility, regional, and national levels in the VHA system in the context of a multispecialty opioid risk reduction program at the North Florida/South Georgia Veteran Health System (NF/SGVHS).
This retrospective study used fiscal years 2012 to 2016 overdose and suicide aggregate data from the US Department of Veterans Affairs (VA) Support Service Center medical diagnosis cube and VA Suicide Prevention Program. Overdose data were aggregated by facility and fiscal year, and overdose rates (per 1,000 individuals) were calculated.
The average annual rate of overdose diagnosis at NF/SGVHS during the study period was slightly higher (16.8 per 1,000) compared with its region (16.0 per 1,000), and VHA national (15.3 per 1,000) rates. The NF/SGVHS had the lowest average annual rate of suicide (9.1 per 100,000) during the study period, which was one-quarter of the VHA national rate.
NF/SGVHS developed and implemented a biopsychosocial model of pain treatment that includes primary care integrated with mental health and addiction services. The presence of this program during a period when the facility was tapering opioid prescriptions could explain the relative reduced suicide rate.
自杀是美国第十大死因，主要原因是药物过量。2017年，67.8%的药物过量死亡案例涉及处方阿片类药物。退伍军人健康管理局（VHA）患者中的阿片类药物使用障碍发生率比非VHA参保者高7倍。本研究在北佛罗里达/南佐治亚退伍军人健康系统（NF/SGVHS）的多专科阿片类药物风险降低项目背景下，比较了VHA系统中各机构、区域和国家层面的药物过量和自杀发生率。
这项回顾性研究使用了美国退伍军人事务部（VA）支持服务中心医疗诊断立方体和VA自杀预防项目2012财年至2016财年的药物过量和自杀汇总数据。药物过量数据按机构和财年汇总，并计算药物过量率（每1000人）。
研究期间，NF/SGVHS的年平均药物过量诊断率（每1000人中有16.8例）略高于其所在区域（每1000人中有16.0例）和VHA全国水平（每1000人中有15.3例）。NF/SGVHS在研究期间的年平均自杀率最低（每10万人中有9.1例），仅为VHA全国水平的四分之一。
NF/SGVHS制定并实施了一种生物心理社会疼痛治疗模式，其中包括将初级保健与心理健康和成瘾服务相结合。在该机构逐渐减少阿片类药物处方的期间，这一项目的存在可能解释了自杀率相对降低的原因。
