School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
PLoS One. 2022 Sep 9;17(9):e0273846. doi: 10.1371/journal.pone.0273846. eCollection 2022.
Interpersonal violence increases vulnerability to the deleterious effects of opioid use. Increased opioid prescription receipt is a major contributor to the opioid crisis; however, our understanding of prescription patterns and risk factors among those with a history of interpersonal violence remains elusive. This study sought to identify 5-year longitudinal patterns of opioid prescription receipt among patients experiencing interpersonal violence within a large healthcare system and sociodemographic and clinical characteristics associated with prescription patterns. This secondary analysis examined electronic health record data from January 2004-August 2019 for a cohort of patients (N = 1,587) referred for interpersonal violence services. Latent class growth analysis was used to estimate trajectories of opioid prescription receipt over a 5-year period. Standardized differences were calculated to assess variation in sociodemographic and clinical characteristics between classes. Our cohort had a high prevalence of prescription opioid receipt (73.3%) and underlying co-morbidities, including chronic pain (54.6%), substance use disorders (39.0%), and mental health diagnoses (76.9%). Six prescription opioid receipt classes emerged, characterized by probability of any prescription opioid receipt at the start and end of the study period (high, medium, low, never) and change in probability over time (increasing, decreasing, stable). Classes with the highest probability of prescription opioids also had the highest proportions of males, chronic pain diagnoses, substance use disorders, and mental health diagnoses. Black, non-Hispanic and Hispanic patients were more likely to be in low or no prescription opioid receipt classes. These findings highlight the importance of monitoring for synergistic co-morbidities when providing pain management and offering treatment that is trauma-informed, destigmatizing, and integrated into routine care.
人际暴力会增加人们对阿片类药物使用的有害影响的易感性。阿片类药物处方的增加是阿片类药物危机的一个主要原因；然而，我们对有过人际暴力史的人的处方模式和风险因素的了解仍然难以捉摸。本研究旨在确定在一个大型医疗保健系统中经历人际暴力的患者在 5 年内接受阿片类药物处方的纵向模式，以及与处方模式相关的社会人口学和临床特征。这项二次分析检查了 2004 年 1 月至 2019 年 8 月期间电子健康记录数据，该数据来自接受人际暴力服务的患者队列（N=1587）。使用潜在类别增长分析来估计 5 年内阿片类药物处方接受的轨迹。计算标准化差异以评估类之间社会人口学和临床特征的差异。我们的队列有很高的处方阿片类药物接受率（73.3%）和潜在的合并症，包括慢性疼痛（54.6%）、物质使用障碍（39.0%）和精神健康诊断（76.9%）。出现了六个阿片类药物处方接受类别，其特征是在研究开始和结束时任何处方阿片类药物接受的概率（高、中、低、从未）以及随时间变化的概率（增加、减少、稳定）。处方阿片类药物概率最高的类别也有最高比例的男性、慢性疼痛诊断、物质使用障碍和精神健康诊断。黑人、非西班牙裔和西班牙裔患者更有可能处于低或无处方阿片类药物接受类别。这些发现强调了在提供疼痛管理时监测协同合并症的重要性，并提供以创伤为中心、去污名化且融入常规护理的治疗方法。
