Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, N.C. (Blalock, Berkowitz, Smith, Grubber); Department of Psychiatry and Behavioral Sciences (Blalock) and Division of General Internal Medicine, Department of Medicine (Smith), Duke University School of Medicine, Durham, N.C.; Institute for Medical Research and Durham Veterans Affairs Health Care System, Durham, N.C. (Berlin); Department of Population Health Sciences, Duke University, Durham, N.C. (Smith); UNC Gillings School of Global Public Health, Chapel Hill (Wright); Center for Clinical Management Research, VA Ann Arbor Healthcare System, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Bachrach); Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Health Care System (Grubber).
Am J Psychiatry. 2024 May 1;181(5):434-444. doi: 10.1176/appi.ajp.20230683.
The co-occurrence of unhealthy alcohol use and opioid misuse is high and associated with increased rates of overdose, emergency health care utilization, and death. The current study examined whether receipt of an alcohol-related brief intervention is associated with reduced risk of negative downstream opioid-related outcomes.
This retrospective cohort study included all VISN-6 Veterans Affairs (VA) patients with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening results (N=492,748) from 2014 to 2019. Logistic regression was used to examine the association between documentation of an alcohol-related brief intervention and probability of a new 1) opioid prescription, 2) opioid use disorder (OUD) diagnosis, or 3) opioid-related hospitalization in the following year, controlling for demographic and clinical covariates.
Of the veterans, 13% (N=63,804) had "positive" AUDIT-C screen results. Of those, 72% (N=46,216) had a documented alcohol-related brief intervention. Within 1 year, 8.5% (N=5,430) had a new opioid prescription, 1.1% (N=698) had a new OUD diagnosis, and 0.8% (N=499) had a new opioid-related hospitalization. In adjusted models, veterans with positive AUDIT-C screen results who did not receive an alcohol-related brief intervention had higher odds of new opioid prescriptions (adjusted odds ratio [OR]=1.10, 95% CI=1.03-1.17) and new OUD diagnoses (adjusted OR=1.19, 95% CI=1.02-1.40), while new opioid-related hospitalizations (adjusted OR=1.19, 95% CI=0.99-1.44) were higher although not statistically significant. Removal of medications for OUD (MOUD) did not impact associations. All outcomes were significantly associated with an alcohol-related brief intervention in unadjusted models.
The VA's standard alcohol-related brief intervention is associated with subsequent lower odds of a new opioid prescription or a new OUD diagnosis. Results suggest a reduction in a cascade of new opioid-related outcomes from prescriptions through hospitalizations.
不健康的酒精使用和阿片类药物滥用同时存在的情况较为普遍，且与过量用药、急诊医疗利用率和死亡风险增加有关。本研究旨在探讨接受酒精相关简短干预是否与降低不良的阿片类药物相关结局风险有关。
本回顾性队列研究纳入了 2014 年至 2019 年间，来自美国退伍军人事务部（VA）第 6 临床医疗网（VISN-6）所有符合酒精使用障碍识别测试-饮酒量（AUDIT-C）筛查结果的患者（N=492748）。采用逻辑回归，控制人口统计学和临床协变量，分析记录的酒精相关简短干预与以下一年内新出现的 1）阿片类药物处方、2）阿片类药物使用障碍（OUD）诊断或 3）阿片类药物相关住院治疗的概率之间的关系。
在退伍军人中，有 13%（N=63804）的人 AUDIT-C 筛查结果呈“阳性”。其中，72%（N=46216）的人接受了记录在案的酒精相关简短干预。在一年内，有 8.5%（N=5430）的人开出了新的阿片类药物处方，1.1%（N=698）的人被诊断出患有新的 OUD，0.8%（N=499）的人发生了新的阿片类药物相关住院治疗。在调整后的模型中，AUDIT-C 筛查结果呈阳性但未接受酒精相关简短干预的退伍军人开出新的阿片类药物处方的可能性更高（调整后的比值比[OR]=1.10，95%可信区间[CI]=1.03-1.17）和新的 OUD 诊断（调整后的 OR=1.19，95% CI=1.02-1.40），而新的阿片类药物相关住院治疗（调整后的 OR=1.19，95% CI=0.99-1.44）虽然不具有统计学意义，但有所增加。排除阿片类药物使用障碍（MOUD）药物治疗不会影响相关性。在未调整的模型中，所有结果均与酒精相关的简短干预显著相关。
VA 的标准酒精相关简短干预与随后开出新的阿片类药物处方或新的 OUD 诊断的可能性较低有关。结果表明，从处方到住院治疗，新的阿片类药物相关结局的发生呈级联式下降。
