Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St., Philadelphia, PA, 19107, USA; Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ, 08901, USA.
Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ, 08901, USA; Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, 89 French St., New Brunswick, NJ, 08901, USA.
Drug Alcohol Depend. 2021 Feb 1;219:108414. doi: 10.1016/j.drugalcdep.2020.108414. Epub 2020 Nov 23.
Adults with mood and anxiety disorders have an increased likelihood of being prescribed opioids. The influence of other mental disorders, such as psychotic and attention disorders, on opioid prescribing patterns is less known.
We studied a population-representative sample of 166,927 outpatient visits for adults with painful conditions from the 2002-2016 National Ambulatory Medical Care Survey and the 2002-2011 National Hospital Ambulatory Medical Care Survey. Logistic regression analyses examined the likelihood of opioid prescription among visits with specific mental disorder diagnoses (anxiety, attention, mood, psychotic, post-traumatic stress disorder (PTSD), opioid use, and non-opioid substance use), adjusted for covariates and weighted for the complex survey design. Secondary analyses stratified results by whether opioids were newly initiated or continued.
Opioids were prescribed at 16.8 % of visits. Mood, anxiety, and non-opioid substance use disorders were associated with higher likelihoods of opioid prescriptions, particularly for continued rather than first-time prescriptions. Psychotic disorders were strongly negatively associated with opioid prescriptions (adjusted odds ratio 0.44, 95 % CI 0.22-0.86). Diagnoses of PTSD and attention disorders were not associated with opioid prescribing.
Outpatient physicians are more likely to prescribe and refill opioids for adults with pain who present with mood, anxiety, and non-opioid substance use disorders, but not for those who present with PTSD or attention disorders. Patients with psychotic disorders and pain are markedly less likely to be prescribed opioids.
患有情绪和焦虑障碍的成年人更有可能被开处阿片类药物。其他精神障碍，如精神病和注意力障碍，对阿片类药物处方模式的影响知之甚少。
我们研究了 2002-2016 年全国门诊医疗调查和 2002-2011 年全国医院门诊医疗调查中 166927 名患有疼痛疾病的成年门诊就诊的代表性人群样本。逻辑回归分析考察了特定精神障碍诊断（焦虑、注意力、情绪、精神病、创伤后应激障碍（PTSD）、阿片类药物使用和非阿片类物质使用）就诊中开处阿片类药物的可能性，调整了协变量并对复杂的调查设计进行了加权。次要分析按是否新开始或继续使用阿片类药物对结果进行分层。
16.8%的就诊开了阿片类药物。情绪、焦虑和非阿片类物质使用障碍与更高的阿片类药物处方可能性相关，尤其是对于继续而不是首次处方。精神病与阿片类药物处方呈强烈负相关（调整后的优势比 0.44，95%CI 0.22-0.86）。PTSD 和注意力障碍的诊断与阿片类药物处方无关。
对于有疼痛症状的成年人，门诊医生更有可能为出现情绪、焦虑和非阿片类物质使用障碍的患者开处和续开阿片类药物，但不会为出现 PTSD 或注意力障碍的患者开处。患有精神病和疼痛的患者开处阿片类药物的可能性明显降低。
