Alcohol and Drug Overdose and the Influence of Pain Conditions in an Addiction Treatment Sample

被引:21
作者
Fernandez, Anne C. [1 ]
Bush, Christopher [2 ]
Bonar, Erin E. [1 ,3 ]
Blow, Frederic C. [1 ,4 ]
Walton, Maureen A. [1 ,3 ]
Bohnert, Amy S. B. [1 ,4 ]
机构
[1] Michigan Med, Dept Psychiat & Addict Ctr, Ann Arbor, MI USA
[2] Duke Univ, Dept Populat Hlth Sci, Durham, NC USA
[3] Michigan Med, Injury Prevent Ctr, Ann Arbor, MI USA
[4] VA Ctr Clin Management Res, Ann Arbor, MI USA
关键词
acute pain; alcohol use disorder; chronic pain; overdose; substance use disorder; PHYSICAL PAIN; UNITED-STATES; OPIOID USE; RISK; SEVERITY; INTERVENTION; PREVALENCE; VALIDATION; DEATHS; TRIAL;
D O I
10.1097/ADM.0000000000000451
中图分类号
R194 [卫生标准、卫生检查、医药管理];
学科分类号
摘要
Purpose: Overdose from alcohol and/or drugs kills tens of thousands of Americans annually, with a large number of deaths attributed to opioid pain medications. Addiction treatment patients are known to be at high risk for overdose; however, the relationship between pain and overdose history within this group is understudied, especially in relation to alcohol overdoses. In the present study, we evaluated whether nonfatal overdose history was more likely among addiction treatment patients with pain, and examined the characteristics of overdoses among those with and without pain. Methods: We analyzed cross-sectional data from 739 patients at a large residential addiction treatment center (median age 37, 25.7% female). We used 2-stepped binary regression models to evaluate whether demographics, pain type (chronic, acute, or both), depression symptoms, and opioid misuse were associated with lifetime history of nonfatal (1) alcohol and (2) drug overdose (lifetime yes/no), and conducted follow-up analyses examining overdose characteristics. Results: In adjusted analyses, history of chronic pain (odds ratio [OR] 2.60, 95% confidence interval [CI] 1.59, 4.27) and illicit drug use (OR 1.99, 95% CI 1.07, 3.68) were associated with an increased likelihood of nonfatal alcohol overdose. Opioid misuse (OR 3.11, 95% CI 2.51, 3.86), depression symptoms (OR 1.33, 95% CI 1.14, 1.55), and younger age (OR 0.96, 95% CI 0.94, 0.97) were associated with increased likelihood of drug overdose. Those with pain reported a higher number of lifetime alcohol overdoses and were more likely to combine numerous drugs with alcohol before overdose. Conclusions: Pain conditions may play an under-recognized role in the overdose epidemic, particularly alcohol-related overdose. Addiction treatment and overdose prevention interventions should incorporate appropriate assessment and treatment of pain including education about the risks of polysubstance use, particularly combining alcohol with sedatives and prescription pain relievers.
引用
收藏
页码:61 / 68
页数:8
相关论文
共 33 条
[1]   Primary Care Patients with Drug Use Report Chronic Pain and Self-Medicate with Alcohol and Other Drugs [J].
Alford, Daniel P. ;
German, Jacqueline S. ;
Samet, Jeffrey H. ;
Cheng, Debbie M. ;
Lloyd-Travaglini, Christine A. ;
Saitz, Richard .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2016, 31 (05) :486-491
[2]  
[Anonymous], 2018, ALC UN
[3]   Evaluation of the Current Opioid Misuse Measure Among Substance Use Disorder Treatment Patients [J].
Ashrafioun, Lisham ;
Bohnert, Amy S. B. ;
Jannausch, Mary ;
Ilgen, Mark A. .
JOURNAL OF SUBSTANCE ABUSE TREATMENT, 2015, 55 :15-20
[4]   A pilot randomized clinical trial of an intervention to reduce overdose risk behaviors among emergency department patients at risk for prescription opioid overdose [J].
Bohnert, Amy S. B. ;
Bonar, Erin E. ;
Cunningham, Rebecca ;
Greenwald, Mark K. ;
Thomas, Laura ;
Chermack, Stephen ;
Blow, Frederic C. ;
Walton, Maureen .
DRUG AND ALCOHOL DEPENDENCE, 2016, 163 :40-47
[5]   Associations among Pain, Non-Medical Prescription Opioid Use, and Drug Overdose History [J].
Bonar, Erin E. ;
Ilgen, Mark A. ;
Walton, Maureen ;
Bohnert, Amy S. B. .
AMERICAN JOURNAL ON ADDICTIONS, 2014, 23 (01) :41-47
[6]   Pain and Use of Alcohol in Later Life: Prospective Evidence from the Health and Retirement Study [J].
Brennan, Penny L. ;
SooHoo, Sonya .
JOURNAL OF AGING AND HEALTH, 2013, 25 (04) :656-677
[7]   Painful Medical Conditions and Alcohol Use: A Prospective Study among Older Adults [J].
Brennan, Penny L. ;
Schutte, Kathleen K. ;
SooHoo, Sonya ;
Moos, Rudolf H. .
PAIN MEDICINE, 2011, 12 (07) :1049-1059
[8]   Non-fatal overdose in the 12 months following treatment for substance use disorders [J].
Britton, Peter C. ;
Wines, James D., Jr. ;
Conner, Kenneth R. .
DRUG AND ALCOHOL DEPENDENCE, 2010, 107 (01) :51-55
[9]   New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults [J].
Brummett, Chad M. ;
Waljee, Jennifer F. ;
Goesling, Jenna ;
Moser, Stephanie ;
Lin, Paul ;
Englesbe, Michael J. ;
Bohnert, Amy S. B. ;
Kheterpal, Sachin ;
Nallamothu, Brahmajee K. .
JAMA SURGERY, 2017, 152 (06)
[10]   Preliminary validation of the Michigan Body Map [J].
Brummett, Chad M. ;
Bakshi, Rishi R. ;
Goesling, Jenna ;
Leung, Daniel ;
Moser, Stephanie E. ;
Zollars, Jennifer W. ;
Williams, David A. ;
Clauw, Daniel J. ;
Hassett, Afton L. .
PAIN, 2016, 157 (06) :1205-1212