Office of the Assistant Secretary for Planning & Evaluation, US Department of Health & Human Services, Washington, DC, USA.
Subst Use Misuse. 2021;56(4):571-574. doi: 10.1080/10826084.2021.1884723. Epub 2021 Feb 26.
People experiencing homelessness have been particularly hard hit by the opioid crisis. This epidemic has also impacted individuals experiencing homelessness in ways that are distinct from how it has impacted individuals with stable housing. However, not much is known about comorbid health conditions and health services utilization among adults with opioid use disorder (OUD) who are experiencing homelessness.
A retrospective observational cohort study was conducted utilizing a large national all-payer electronic health record database. The sample for the analysis is comprised of 2,080 individuals with OUD who had an ICD-10 Z code of homelessness (Z59.0), and the comparison group includes 980 individuals with OUD covered under Medicaid who were matched on age and gender to the homeless population.
Higher rates of mental health conditions such as bipolar disorder (48%) and schizophrenia (22%) were present among individuals with OUD experiencing homelessness compared to individuals with OUD covered under Medicaid not experiencing homelessness (26% and 8%, respectively). In addition, higher rates of alcohol (44%) and stimulant abuse (30%) were also present among the patients compared to the comparison group (29% and 9%, respectively). Utilization of buprenorphine for OUD and treatment for mental health conditions were low among the patients experiencing homelessness.
Underlying mental health conditions and polysubstance use contribute toward making individuals experiencing homelessness more susceptible to adverse health outcomes associated with OUD. Health policy initiatives directed toward treatment engagement might benefit from an emphasis on addressing housing instability that many individuals with OUD might be experiencing.
无家可归者受到阿片类药物危机的严重影响。这场流行病也以不同于影响有稳定住房的个人的方式影响了无家可归者。然而，对于患有阿片类药物使用障碍（OUD）且无家可归的成年人的合并健康状况和卫生服务利用情况，我们知之甚少。
利用大型全国性所有支付者电子健康记录数据库进行回顾性观察队列研究。分析的样本由 2080 名患有 OUD 且具有 ICD-10 无家可归 Z 代码（Z59.0）的个体组成，对照组包括 980 名在医疗补助计划下患有 OUD 且与无家可归者在年龄和性别上相匹配的个体。
与无家可归的 OUD 患者相比，患有 OUD 且无家可归的个体中存在更高的精神健康状况，如双相情感障碍（48%）和精神分裂症（22%），而无家可归的 OUD 患者则分别为 26%和 8%。此外，与对照组（分别为 29%和 9%）相比，患者中还存在更高的酒精（44%）和兴奋剂滥用（30%）率。接受 OUD 治疗和治疗精神健康状况的丁丙诺啡利用率在无家可归者中较低。
潜在的心理健康状况和多种物质使用使无家可归者更容易受到与 OUD 相关的不良健康后果的影响。针对治疗参与的卫生政策举措可能受益于强调解决许多 OUD 患者可能面临的住房不稳定问题。
