Ngo Thye Peng, Keyhani Salomeh, Leonard Samuel, Hoggatt Katherine J
Center for Data to Discovery and Delivery Innovation (3DI), San Francisco VA Health Care System, CA, USA.
National Clinician Scholars Program (NCSP) at UCSF, San Francisco, CA, USA.
Drug Alcohol Depend Rep. 2025 May 19;16:100347. doi: 10.1016/j.dadr.2025.100347. eCollection 2025 Sep.
Few studies have reported on the prevalence and health risks associated with substance use and substance use disorder (SU/SUD) in Veterans who use long-term opioid therapy (LTOT). We leveraged health record data to estimate SU/SUD prevalence and its association with mortality among Veterans on LTOT.
We conducted a secondary analysis of cohort data for Veterans on LTOT within Veterans Health Administration outpatient settings (2014-2019). SU/SUD was defined as a positive screen for risky alcohol use; a positive urine drug screen for cannabis, benzodiazepines, or stimulants; or a documented SUD diagnosis. We fit Cox models for all-cause mortality, fatal overdose, and traumatic deaths, comparing Veterans on LTOT with SU/SUD vs. LTOT-only.
One in four (25.0 %) Veterans on LTOT have risky alcohol use, tested positive for other substances, or had a diagnosed SUD. Alcohol was the most common SU/SUD (9.8 %), followed by sedative (8.1 %), cannabis (6.6 %), and stimulant (0.6 %). Relative to Veterans on LTOT only, mortality rates were higher for Veterans on LTOT with cannabis (HR=1.16, 95 % CI=1.03, 1.30), sedative (HR=1.29, 95 % CI=1.10, 1.52), or stimulant SU/SUD (HR=1.54, 95 % CI=1.17, 2.02). Fatal overdose rates were higher for LTOT with alcohol (HR=1.43, 95 % CI=1.10, 1.86), sedatives (HR=1.40, 95 % CI=1.04, 1.91), or stimulant SU/SUD (HR=3.29, 95 % CI=1.60, 6.77). LTOT with sedative SU/SUD was associated with traumatic death rates (HR=1.30, 95 % CI=1.05, 1.61).
Substance co-use is common among Veterans on LTOT and is associated with elevated mortality and overdose risks. Comprehensive screening and targeted interventions may be needed.
很少有研究报告长期使用阿片类药物治疗（LTOT）的退伍军人中物质使用及物质使用障碍（SU/SUD）的患病率和健康风险。我们利用健康记录数据来估计LTOT退伍军人中SU/SUD的患病率及其与死亡率的关联。
我们对退伍军人健康管理局门诊环境中接受LTOT的退伍军人队列数据进行了二次分析（2014 - 2019年）。SU/SUD被定义为危险饮酒筛查呈阳性；大麻、苯二氮卓类药物或兴奋剂的尿液药物筛查呈阳性；或有记录的物质使用障碍诊断。我们对全因死亡率、致命过量用药和创伤性死亡拟合了Cox模型，比较了伴有SU/SUD的LTOT退伍军人与仅接受LTOT的退伍军人。
接受LTOT的退伍军人中有四分之一（25.0%）存在危险饮酒、其他物质检测呈阳性或被诊断为物质使用障碍。酒精是最常见的SU/SUD（9.8%），其次是镇静剂（8.1%）、大麻（6.6%）和兴奋剂（0.6%）。与仅接受LTOT的退伍军人相比，使用大麻（HR = 1.16，95%CI = 1.03，1.30）、镇静剂（HR = 1.29，95%CI = 1.10，1.52）或兴奋剂SU/SUD的LTOT退伍军人死亡率更高。酒精（HR = 1.43，95%CI = 1.10，1.86）、镇静剂（HR = 1.40，95%CI = 1.04，1.91）或兴奋剂SU/SUD的LTOT致命过量用药率更高。伴有镇静剂SU/SUD的LTOT与创伤性死亡率相关（HR = 1.30，95%CI = 1.05，1.61）。
物质共同使用在接受LTOT的退伍军人中很常见，并且与死亡率和过量用药风险升高相关。可能需要进行全面筛查和有针对性的干预。
