Palliative Care Program, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA.
Geriatrics Research, Education, and Clinical Center, LTC Charles S. Kettles VA Medical Center, Ann Arbor, MI, USA.
J Gen Intern Med. 2023 Feb;38(3):699-706. doi: 10.1007/s11606-022-07732-w. Epub 2022 Jul 11.
BACKGROUND: Patterns of opioid use vary, including prescribed use without aberrancy, limited aberrant use, and potential opioid use disorder (OUD). In clinical practice, similar opioid-related International Classification of Disease (ICD) codes are applied across this spectrum, limiting understanding of how groups vary by sociodemographic factors, comorbidities, and long-term risks. OBJECTIVE: (1) Examine how Veterans assigned opioid abuse/dependence ICD codes vary at diagnosis and with respect to long-term risks. (2) Determine whether those with limited aberrant use share more similarities to likely OUD vs those using opioids as prescribed. DESIGN: Longitudinal observational cohort study. PARTICIPANTS: National sample of Veterans categorized as having (1) likely OUD, (2) limited aberrant opioid use, or (3) prescribed, non-aberrant use based upon enhanced medical chart review. MAIN MEASURES: Comparison of sociodemographic and clinical factors at diagnosis and rates of age-adjusted mortality, non-fatal opioid overdose, and hospitalization after diagnosis. An exploratory machine learning analysis investigated how closely those with limited aberrant use resembled those with likely OUD. KEY RESULTS: Veterans (n = 483) were categorized as likely OUD (62.1%), limited aberrant use (17.8%), and prescribed, non-aberrant use (20.1%). Age, proportion experiencing homelessness, chronic pain, anxiety disorders, and non-opioid substance use disorders differed by group. All-cause mortality was high (44.2 per 1000 person-years (95% CI 33.9, 56.7)). Hospitalization rates per 1000 person-years were highest in the likely OUD group (831.5 (95% CI 771.0, 895.5)), compared to limited aberrant use (739.8 (95% CI 637.1, 854.4)) and prescribed, non-aberrant use (411.9 (95% CI 342.6, 490.4). The exploratory analysis reclassified 29.1% of those with limited aberrant use as having likely OUD with high confidence. CONCLUSIONS: Veterans assigned opioid abuse/dependence ICD codes are heterogeneous and face variable long-term risks. Limited aberrant use confers increased risk compared to no aberrant use, and some may already have OUD. Findings warrant future investigation of this understudied population.
背景：阿片类药物的使用模式存在差异，包括无异常的处方使用、有限的异常使用和潜在的阿片类药物使用障碍（OUD）。在临床实践中，相似的阿片类药物相关国际疾病分类（ICD）代码在整个范围内使用，这限制了我们对不同群体在社会人口因素、合并症和长期风险方面差异的理解。 目的：（1）检查被诊断为阿片类药物滥用/依赖 ICD 代码的退伍军人在诊断时以及在长期风险方面的差异。（2）确定那些有限的异常使用与可能的 OUD 相比，与那些按规定使用阿片类药物的人有更多的相似之处。 设计：纵向观察队列研究。 参与者：根据增强医疗记录审查，将全国退伍军人样本分为（1）可能患有 OUD，（2）有限的异常阿片类药物使用，或（3）按规定、非异常使用。 主要测量指标：诊断时社会人口学和临床因素的比较，以及年龄调整后的死亡率、非致命性阿片类药物过量和诊断后住院率。一项探索性机器学习分析调查了那些有限的异常使用与可能的 OUD 有多相似。 主要结果：退伍军人（n=483）被归类为可能的 OUD（62.1%）、有限的异常使用（17.8%）和规定的非异常使用（20.1%）。年龄、无家可归比例、慢性疼痛、焦虑障碍和非阿片类物质使用障碍因组而异。全因死亡率很高（每 1000 人年 44.2 人（95%CI 33.9，56.7））。每 1000 人年的住院率以可能 OUD 组最高（831.5（95%CI 771.0，895.5）），其次是有限的异常使用组（739.8（95%CI 637.1，854.4））和规定的非异常使用组（411.9（95%CI 342.6，490.4））。探索性分析以高置信度重新分类了 29.1%的有限异常使用为可能的 OUD。 结论：被诊断为阿片类药物滥用/依赖 ICD 代码的退伍军人是异质的，面临着不同的长期风险。与无异常使用相比，有限的异常使用会带来更高的风险，而且有些人可能已经患有 OUD。研究结果值得进一步研究这一研究不足的人群。
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