Bhondoekhan Fiona, Li Yu, Gaither Rachel, Daly Mackenzie M, Hallowell Benjamin D, Chambers Laura C, Beaudoin Francesca L, Marshall Brandon D L
Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA.
Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, 14 Harrington Rd, Cranston, RI 02920, USA.
Addict Behav Rep. 2023 Aug 12;18:100512. doi: 10.1016/j.abrep.2023.100512. eCollection 2023 Dec.
Substance use patterns are diverse, and multiple substances are often involved in fatal and nonfatal overdoses. Additionally, polysubstance use is associated with greater difficulty accessing and remaining in substance use disorder (SUD) treatment. The aim of this study was to identify substance use patterns and determine their association with SUD treatment engagement among emergency department (ED) patients at risk of opioid overdose.
This was a sub-analysis of a randomized controlled trial comparing two behavioral interventions for individuals at two EDs in Rhode Island from 2018 to 2021. Past six-month substance use frequency for eight substances plus injection drug use was self-reported at trial enrollment, and SUD treatment engagement within 90 days after enrollment was obtained using administrative data linkages. Latent class analysis identified substance use patterns and multivariable log-binomial models estimated the association with SUD treatment engagement.
Among 607 participants, there were four substance use patterns: 1) low reported use (n = 295), 2) frequent injection and heroin use (n = 131), 3) high frequency broad polysubstance use (n = 62), and 4) low frequency broad polysubstance use (n = 119). Compared to participants with the low reported use pattern, those with the frequent injection and heroin pattern had a greater likelihood of SUD treatment engagement (adjusted risk ratio = 1.28; 95% confidence interval = 1.02-1.61).
Distinct and meaningful polysubstance use patterns showed differential SUD treatment engagement after ED discharge. Nuanced relationships between substance use patterns and treatment highlight the necessity for tailored harm reduction, treatment, and recovery services.
物质使用模式多种多样，致命和非致命过量用药事件中往往涉及多种物质。此外，多物质使用与获得物质使用障碍（SUD）治疗及维持治疗的难度增加有关。本研究的目的是确定物质使用模式，并确定其与有阿片类药物过量风险的急诊科（ED）患者接受SUD治疗的相关性。
这是一项随机对照试验的子分析，该试验比较了2018年至2021年罗德岛州两家急诊科针对个体的两种行为干预措施。在试验入组时，通过自我报告过去六个月八种物质的使用频率以及注射吸毒情况，并使用行政数据链接获取入组后90天内的SUD治疗参与情况。潜在类别分析确定物质使用模式，多变量对数二项式模型估计与SUD治疗参与的相关性。
在607名参与者中，有四种物质使用模式：1）低报告使用量（n = 295），2）频繁注射和使用海洛因（n = 131），3）高频广泛多物质使用（n = 62），4）低频广泛多物质使用（n = 119）。与低报告使用模式的参与者相比，频繁注射和使用海洛因模式的参与者接受SUD治疗的可能性更大（调整风险比 = 1.28；95%置信区间 = 1.02 - 1.61）。
不同且有意义的多物质使用模式在急诊科出院后显示出不同的SUD治疗参与情况。物质使用模式与治疗之间的细微关系凸显了提供量身定制的减少伤害、治疗和康复服务的必要性。
