Strong Cameron, Burns Stephen P, Arewasikporn Anne, Suri Pradeep, Hawkins Eric J, Leipertz Steve, Haselkorn Jodie, Turner Aaron P
VA Puget Sound Health Care System, Seattle, Washington, USA.
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
J Spinal Cord Med. 2024 Jul 25:1-11. doi: 10.1080/10790268.2024.2378556.
Chronic opioid use presents long-term health risks for individuals with spinal cord injury (SCI). The purpose of the study was to characterize patterns and correlates of the chronic prescription of opioids among individuals with SCI in a population of Veterans receiving care though the Veteran's Health Administration.
A retrospective, longitudinal cohort study examined the US Department of Veterans Affairs electronic medical record data of veterans with SCI. The annual prevalence of prescription opioid use by type (any, acute, chronic, incident chronic) was calculated for each study year (2015-2017). Multivariable models examined associations with demographics and pre-existing medical comorbidities.
US Department of Veterans Affairs, Veteran's Health Administration.
National sample of Veterans with SCI ( = 10,811).
Chronic prescription opioid use (≥90 days).
All types of prescription opioid use declined across the three study years (chronic opioid use prevalence = 33.2%, 31.7%, and 29.7%, respectively). Past history of depression, COPD, diabetes, pain condition, opioid use and tobacco use disorders were associated with a greater likelihood of current chronic prescription opioid use. Non-white race, hyperlipidemia, dementia, and tetraplegia were associated with a lower likelihood of current chronic prescription opioid use. When added to the multivariable model, prior chronic opioid prescription use was robustly associated with current chronic prescription opioid use, but most other factors were no longer significantly associated with current opioid use.
This study demonstrates opioid reduction over time from 2015 to 2017, however, chronic prescription opioid use remains common among a substantial minority of Veterans with SCI. Several demographics and comorbidities may provide clinicians with important insights into factors associated with chronic prescription opioid use, with past chronic prescription opioid use being the most important.
长期使用阿片类药物会给脊髓损伤（SCI）患者带来长期健康风险。本研究的目的是描述通过退伍军人健康管理局接受治疗的退伍军人中，SCI患者长期使用阿片类药物的模式及相关因素。
一项回顾性纵向队列研究，对患有SCI的退伍军人的美国退伍军人事务部电子病历数据进行了检查。计算了每个研究年份（2015 - 2017年）按类型（任何、急性、慢性、新发慢性）划分的处方阿片类药物使用的年度患病率。多变量模型研究了与人口统计学和既往医疗合并症的关联。
美国退伍军人事务部，退伍军人健康管理局。
患有SCI的退伍军人全国样本（n = 10,811）。
长期处方阿片类药物使用（≥90天）。
在三个研究年份中，所有类型的处方阿片类药物使用均呈下降趋势（慢性阿片类药物使用患病率分别为33.2%、31.7%和29.7%）。抑郁症、慢性阻塞性肺疾病（COPD）、糖尿病、疼痛状况、阿片类药物使用和烟草使用障碍的既往史与当前长期处方阿片类药物使用的可能性更大相关。非白人种族、高脂血症、痴呆和四肢瘫痪与当前长期处方阿片类药物使用的可能性较低相关。当添加到多变量模型中时，既往长期阿片类药物处方使用与当前长期处方阿片类药物使用密切相关，但大多数其他因素与当前阿片类药物使用不再显著相关。
本研究表明，从2015年到2017年，阿片类药物的使用随时间减少，然而，长期处方阿片类药物使用在相当一部分患有SCI的退伍军人中仍然很常见。一些人口统计学和合并症可能为临床医生提供与长期处方阿片类药物使用相关因素的重要见解，其中既往长期处方阿片类药物使用是最重要的因素。
