From the Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA (PJJ); Department of Medicine, UCSF School of Medicine, San Francisco, CA (MW); VA Connecticut Healthcare System, West Haven, CT (ED); Pain Research, Informatics, Multi-morbidities, and Education Center, Department of Veterans Affairs, West Haven, CT (ED); Center of Innovation for Veteran Centered and Value-Driven Care, VA Puget Sound, Seattle, WA (ECW); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA (ECW); Department of Internal Medicine, Yale School of Medicine, New Haven, CT (EJE); and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE).
J Addict Med. 2024;18(3):293-299. doi: 10.1097/ADM.0000000000001291. Epub 2024 Mar 27.
Long-term opioid therapy (LTOT) is potentially dangerous among patients with unhealthy alcohol use because of possible adverse interactions. We examined receipt of alcohol-related care among patients with unhealthy alcohol use receiving LTOT and without opioid receipt.
We use data collected from 2009 to 2017 in the Women Veterans Cohort Study, a national cohort of Veterans engaged in Veterans Health Administration care. We included patients who screened positive for unhealthy alcohol use (score ≥5) using the Alcohol Use Disorder Identification Consumption questionnaire. Our primary exposure was LTOT (receipt of prescribed opioids for ≥90 days) versus no opioid receipt at the time of the first positive Alcohol Use Disorder Identification Consumption. Our primary outcome was receipt of brief intervention within 14 days of positive alcohol screen. Unadjusted and 4 adjusted modified Poisson regression models assessed prevalence and relative rates (RRs) of outcomes.
Among eligible veterans, 6222 of 113,628 (5.5%) received LTOT at screening. Among patients receiving LTOT, 67.5% (95% confidence interval [CI], 66.3%-68.6%) had a documented brief intervention within 14 days of positive screen, compared with 70.1% (95% CI, 69.8%-70.4%) among patients without opioid receipt (RR, 0.96; 95% CI, 0.95-0.98; P < 0.001). Within adjusted models, the rate of brief intervention among patients receiving LTOT remained lower than patients without opioid receipt.
Among patients with unhealthy alcohol use, patients receiving LTOT had significantly lower rates of brief intervention receipt compared with those without opioid receipt, and they should be a focus for interventions to improve alcohol-related care and safer opioid prescribing.
长期阿片类药物治疗（LTOT）在有不健康饮酒史的患者中存在潜在危险，因为可能存在不良相互作用。我们研究了接受 LTOT 治疗且未接受阿片类药物治疗的有不健康饮酒史患者的酒精相关治疗情况。
我们使用了 2009 年至 2017 年期间在妇女退伍军人队列研究中收集的数据，该研究是一项全国性的退伍军人参与退伍军人健康管理局护理的队列研究。我们纳入了使用酒精使用障碍识别消耗问卷（Alcohol Use Disorder Identification Consumption questionnaire）筛查出有不健康饮酒史（得分≥5）的患者。我们的主要暴露因素是 LTOT（接受处方阿片类药物治疗≥90 天）与首次阳性酒精使用障碍识别消耗时未接受阿片类药物治疗。我们的主要结果是在阳性酒精筛查后 14 天内接受简短干预的情况。未调整和 4 种调整后的修正泊松回归模型评估了结果的患病率和相对比率（RR）。
在合格的退伍军人中，113628 例患者中有 6222 例（5.5%）在筛查时接受 LTOT。在接受 LTOT 的患者中，有 67.5%（95%置信区间[CI]，66.3%-68.6%）在阳性筛查后 14 天内有记录的简短干预，而未接受阿片类药物治疗的患者为 70.1%（95%CI，69.8%-70.4%）（RR，0.96；95%CI，0.95-0.98；P < 0.001）。在调整后的模型中，接受 LTOT 的患者的简短干预率仍低于未接受阿片类药物治疗的患者。
在有不健康饮酒史的患者中，接受 LTOT 的患者接受简短干预的比例明显低于未接受阿片类药物治疗的患者，他们应成为干预措施的重点，以改善酒精相关治疗和更安全的阿片类药物处方。
