Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Dig Dis Sci. 2021 Nov;66(11):3938-3950. doi: 10.1007/s10620-020-06742-0. Epub 2021 Jan 1.
In a cohort of Veterans dually enrolled in the Department of Veterans Affairs (VA) and Medicare Part D, we sought to describe high-dose daily opioid use among Veterans with unexplained gastrointestinal (GI) symptoms and structural GI diagnoses and examine factors associated with high-dose use.
We used linked national patient-level data from the VA and Centers for Medicare and Medicaid Services (CMS). We grouped patients into 3 subsets: those with unexplained GI symptoms (e.g., chronic abdominal pain); structural GI diagnoses (e.g., chronic pancreatitis); and those with a concurrent unexplained GI symptom and structural GI diagnosis. High-dose daily opioid use levels were examined as a binary variable [≥ 100 morphine milligram equivalents (MME)/day] and as an ordinal variable (50-99 MME/day, 100-119 MME/day, or ≥ 120 MME/day).
We identified 141,805 chronic GI patients dually enrolled in VA and Part D. High-dose opioid use was present in 11% of Veterans with unexplained GI symptoms, 10% of Veterans with structural GI diagnoses, and 15% of Veterans in the concurrent GI group. Compared to Veterans with only an unexplained GI symptom or structural diagnosis, concurrent GI patients were more likely to have higher daily opioid doses, more opioid days ≥ 100 MME, and higher risk of chronic use. Factors associated with high-dose use included opioid receipt from both VA and Part D, younger age, and benzodiazepine use.
A significant subset of chronic GI patients in the VA are high-dose opioid users. Efforts are needed to reduce high-dose use among Veterans with concurrent GI symptoms and diagnoses.
在同时参加退伍军人事务部 (VA) 和医疗保险部分 D 的退伍军人队列中，我们试图描述有不明胃肠道 (GI) 症状和结构性 GI 诊断的退伍军人中高剂量每日阿片类药物的使用情况，并研究与高剂量使用相关的因素。
我们使用来自退伍军人事务部和医疗保险和医疗补助服务中心 (CMS) 的全国患者水平的链接数据。我们将患者分为 3 个亚组：有不明胃肠道症状的患者（例如，慢性腹痛）；结构性胃肠道诊断（例如，慢性胰腺炎）；以及同时存在不明胃肠道症状和结构性胃肠道诊断的患者。高剂量每日阿片类药物使用水平作为二项变量[≥100 吗啡毫克当量 (MME)/天]和有序变量（50-99 MME/天、100-119 MME/天或≥120 MME/天）进行检查。
我们确定了 141,805 名同时参加 VA 和 Part D 的慢性 GI 患者。有 11%的有不明胃肠道症状的退伍军人、10%的有结构性胃肠道诊断的退伍军人和 15%的同时有胃肠道症状和诊断的退伍军人使用高剂量阿片类药物。与仅有不明胃肠道症状或结构性诊断的退伍军人相比，同时有胃肠道症状和诊断的退伍军人更有可能使用更高剂量的阿片类药物，更多的阿片类药物使用天数≥100 MME，以及更高的慢性使用风险。与高剂量使用相关的因素包括从 VA 和 Part D 同时获得阿片类药物、年龄较小和使用苯二氮䓬类药物。
VA 中有相当一部分慢性 GI 患者是高剂量阿片类药物使用者。需要努力减少同时有胃肠道症状和诊断的退伍军人中高剂量的使用。
