Objective To study the association between benzodiazepine prescribing patterns including dose, type, and dosing schedule and the risk of death from drug overdose among US veterans receiving opioid ...analgesics.Design Case-cohort study.Setting Veterans Health Administration (VHA), 2004-09.Participants US veterans, primarily male, who received opioid analgesics in 2004-09. All veterans who died from a drug overdose (n=2400) while receiving opioid analgesics and a random sample of veterans (n=420 386) who received VHA medical services and opioid analgesics.Main outcome measure Death from drug overdose, defined as any intentional, unintentional, or indeterminate death from poisoning caused by any drug, determined by information on cause of death from the National Death Index.Results During the study period 27% (n=112 069) of veterans who received opioid analgesics also received benzodiazepines. About half of the deaths from drug overdose (n=1185) occurred when veterans were concurrently prescribed benzodiazepines and opioids. Risk of death from drug overdose increased with history of benzodiazepine prescription: adjusted hazard ratios were 2.33 (95% confidence interval 2.05 to 2.64) for former prescriptions versus no prescription and 3.86 (3.49 to 4.26) for current prescriptions versus no prescription. Risk of death from drug overdose increased as daily benzodiazepine dose increased. Compared with clonazepam, temazepam was associated with a decreased risk of death from drug overdose (0.63, 0.48 to 0.82). Benzodiazepine dosing schedule was not associated with risk of death from drug overdose.Conclusions Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of death from drug overdose in a dose-response fashion.
Background and Aims
Limited information is available regarding links between specific substance use disorders (SUDs) and suicide mortality; however, the preliminary evidence that is available ...suggests that suicide risk associated with SUDs may differ for men and women. This study aimed to estimate associations between SUDs and suicide for men and women receiving Veterans Health Administration (VHA) care.
Design
A cohort study using national administrative health records.
Setting
National VHA system, USA.
Participants
All VHA users in fiscal year (FY) 2005 who were alive at the beginning of FY 2006 (n = 4 863 086).
Measurements
The primary outcome of suicide mortality was assessed via FY 2006–2011 National Death Index (NDI) records. Current SUD diagnoses were the primary predictors of interest, and were assessed via FY 2004–2005 VHA National Patient Care Database (NPCD) records.
Findings
In unadjusted analyses, a diagnosis of any current SUD and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were all associated significantly with increased risk of suicide for both males and females hazard ratios (HRs) ranging from 1.35 for cocaine use disorder to 4.74 for sedative use disorder for men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder for women. Further, the HR estimates for the relations between any SUD, alcohol, cocaine and opioid use disorders and suicide were significantly stronger for women than men (P < 0.05). After adjustment for other factors, most notably comorbid psychiatric diagnoses, associations linking SUDs with suicide were attenuated markedly and the greater suicide risk among females was observed for only any SUD and opioid use disorder (P < 0.05).
Conclusions
Current substance use disorders (SUDs) signal increased suicide risk, especially among women, and may be important markers to consider including in suicide risk assessment strategies. None the less, other co‐occurring psychiatric disorders may partially explain associations between SUDs and suicide, as well as the observed excess suicide risk associated with SUDs among women.
Abstract Objectives Cannabis has been legalized for medical use in almost half of the states in the U.S. Although laws in these states make the distinction between medical and recreational use of ...cannabis, the prevalence of people using medical cannabis and how distinct this group is from individuals using cannabis recreationally is unknown at a national level. Methods Data came from the 2013 National Survey on Drug Use and Health (NSDUH). All adults endorsing past year cannabis use who reported living in a state that had legalized medical cannabis were divided into recreational cannabis use only and medical cannabis use. Demographic and clinical characteristics were compared across these two groups. Results 17% of adults who used cannabis in the past year used cannabis medically. There were no significant differences between those who used medically versus recreationally in race, education, past year depression and prevalence of cannabis use disorders. In adjusted analyses, those with medical cannabis use were more likely to have poorer health and lower levels of alcohol use disorders and non-cannabis drug use. A third of those who reported medical cannabis use endorsed daily cannabis use compared to 11% in those who reported recreational use exclusively. Conclusions Adults who use medical and recreational cannabis shared some characteristics, but those who used medical cannabis had higher prevalence of poor health and daily cannabis use. As more states legalize cannabis for medical use, it is important to better understand similarities and differences between people who use cannabis medically and recreationally.
The Veterans Health Administration (VHA) designed the Opioid Safety Initiative (OSI) to help decrease opioid prescribing practices associated with adverse outcomes. Key components included ...disseminating a dashboard tool that aggregates electronic medical record data to audit real-time opioid-related prescribing and identifying a clinical leader at each facility to implement the tool and promote safer prescribing. This study examines changes associated with OSI implementation in October 2013 among all adult VHA patients who filled outpatient opioid prescriptions. Interrupted time series analyses controlled for baseline trends and examined data from October 2012 to September 2014 to determine the changes after OSI implementation in prescribing of high-dosage opioid regimens (total daily dosages >100 morphine equivalents MEQ and >200 MEQ) and concurrent benzodiazepines. Across VHA facilities nationwide, there was a decreasing trend in high-dosage opioid prescribing with 55,722 patients receiving daily opioid dosages >100 MEQ in October 2012, which decreased to 46,780 in September 2014 (16% reduction). The OSI was associated with an additional decrease, compared to pre-OSI trends, of 331 patients per month (95% confidence interval CI -378 to -284) receiving opioids >100 MEQ, a decrease of 164 patients per month (95% CI -186 to -142) receiving opioids >200 MEQ, and a decrease of 781 patients per month (95% CI -969 to -593) receiving concurrent benzodiazepines. Implementation of a national health care system-wide initiative was associated with reductions in outpatient prescribing of risky opioid regimens. These findings provide evidence for the potential utility of large-scale interventions to promote safer opioid prescribing.
Background and aims
Brief alcohol interventions in medical settings are efficacious in improving self‐reported alcohol consumption among those with low‐severity alcohol problems. Screening, Brief ...Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral‐specific component, in increasing the utilization of alcohol‐related care.
Methods
A systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health‐care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post‐treatment alcohol services utilization assessed by self‐report or administrative data, which we compared across intervention and control groups.
Results
Thirteen RCTs met inclusion criteria and nine were meta‐analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92–1.28. Five studies compared referral‐specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81–1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non‐statistically significant results.
Conclusions
There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol‐related services.
•Suicidality in supplemental nutrition assistance program (SNAP) participants is not known.•SNAP could provide a novel setting for reaching those with high prevalence of suicidality.•Suicidality was ...more common among SNAP participants than nonparticipants.•In fully adjusted age-stratified models, associations remained for those aged <50.•SNAP recipients may benefit from interventions targeting mental health.
Suicide represents a substantial public health problem in the U.S. Programs like the Supplemental Nutrition Assistance Program (SNAP)—which provides services for U.S. adults who are food insecure—could be an appropriate venue for suicide prevention strategies targeting high-risk individuals.
This cross-sectional study used multiple logistic regression to determine odds ratios (ORs) and 95% confidence intervals (CIs) for suicide ideation, planning and attempt among those who participated in SNAP vs. nonparticipants. The National Survey of Drug Use and Health provided a representative sample of U.S. adults for 2012–2018 (n = 288,730).
SNAP participants were more likely than nonparticipants to have serious suicidal thoughts (crude OR=1.89; 95% CI=1.79–1.99), to have a plan for suicide (crude OR=2.35; 95% CI=2.16–2.56) or to attempt suicide (crude OR=2.89; 95% CI=2.54–3.29). Associations remained for those aged <50 in age-stratified analyses that accounted for survey year, demographics, socioeconomic status, self-rated health and mental health service use.
SNAP was assessed at the household level; thus, those who reported suicidal thoughts and/or behaviors may not personally interact with SNAP.
Using a large, nationally-representative sample of U.S. adults, this study documented greater prevalence of suicide-related outcomes among those who participate in SNAP. Suicide prevention among SNAP participants may provide a unique means to reach individuals who are often hard to engage in other health services.
Abstract Background The abuse of synthetic cannabinoids has emerged as a public health concern over the past few years, yet little data exist characterizing the use of synthetic cannabinoids, ...particularly among patients seeking substance use disorder (SUD) treatment. In a sample of patients entering residential SUD treatment, we examined the prevalence of and motivations for synthetic cannabinoid use, and examined relationships of synthetic cannabinoid use with other substance use and demographic characteristics. Methods Patients ( N = 396; 67% male, 75% White, Mage = 34.8) completed self-report screening surveys about lifetime prevalence of synthetic cannabinoid use, route of administration, and motives for use. Results A total of 150 patients (38%) reported using synthetic cannabinoids in their lifetimes, primarily by smoking (91%). Participants chose multiple motives for use and the most commonly endorsed included curiosity (91%), feeling good/getting high (89%), relaxation (71%), and getting high without having a positive drug test (71%). Demographically, those who used synthetic cannabinoids were younger and more were White. They had higher rates of other substance use and higher scores on measures of depression and psychiatric distress. Conclusions Lifetime synthetic cannabinoid use was relatively common in SUD patients and many of those who used it reported doing so because they believed it would not result in a positive drug test. Further research is needed to characterize the extent of synthetic cannabinoid use among SUD treatment samples, and to establish understanding of the longitudinal trajectories of synthetic cannabinoid use in combination with other substance use, psychiatric distress, and treatment outcomes.
Opioid dose and risk of suicide Ilgen, Mark A; Bohnert, Amy S B; Ganoczy, Dara ...
Pain (Amsterdam),
05/2016, Letnik:
157, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Chronic pain is associated with increased risk of suicide, and opioids are commonly used to treat moderate to severe pain. However, the association between opioid dose and suicide mortality has not ...been examined closely. This retrospective data analysis described the risk of suicide associated with differing prescribed opioid doses. Data were from Veterans Affairs health care system treatment records and the National Death Index. Records analyzed were those of Veterans Affairs patients with chronic pain receiving opioids in fiscal years 2004 to 2005 (N = 123,946). Primary predictors were maximum prescribed morphine-equivalent daily opioid dose and opioid fill type. The main outcome measured was suicide death, by any mechanism, and intentional overdose death during 2004 to 2009. Controlling for demographic and clinical characteristics, higher prescribed opioid doses were associated with elevated suicide risk. Compared with those receiving ≤20 milligrams/day (mg/d), hazard ratios were 1.48 (95% confidence intervals CI, 1.25-1.75) for 20 to <50 mg/d, 1.69 (95% CI, 1.33-2.14) for 50 to <100 mg/d, and 2.15 (95% CI, 1.64-2.81) for 100+ mg/d. The magnitude of association between opioid dose and suicide by intentional overdose was not substantially different from that observed for the overall measure of suicide mortality. Risk of suicide mortality was greater among individuals receiving higher doses of opioids, and treatment providers may want to view high opioid dose as a marker of elevated risk for suicide. Additional research is needed on opioid use, pain treatment, and suicide.
Opioid-related mortality has increased in the United States in the past decade. The purpose of this study was to examine trends and regional variation in opioid prescribing and overdose rates in a ...national health system, the Veterans Health Administration.
Annual cohorts of Veterans Health Administration patients were identified on the basis of medical records, and overdose mortality was determined from National Death Index records. State-level prescribing and overdose rates were mapped to provide information on regional variability.
There were significant increases between 2001 and 2009 in the rate of overdoses associated with nonsynthetic opioids (β=0.53, 95% confidence interval, 0.35, 0.70) and methadone (β=0.63, 95% confidence interval, 0.37, 0.90) but not synthetic/semisynthetic opioids. State-level overdose rates had a moderate correlation with the average proportion of patients in that state receiving opioids (r=0.29).
The present study demonstrates that the increases in prescription opioid overdoses observed in the general population are also found in the patient population of a national health system and provides further evidence of the population-level association between trends in opioid prescribing and opioid overdose deaths. There is substantial regional variation in both opioid prescribing and opioid-related overdose rates, and these data can inform region-specific overdose prevention strategies and opioid policy.
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