Abstract Objective: Opioid use disorder (OUD) is a notable concern in the United States (US) and strongly associated with mortality. There is a high prevalence of OUD in patients with posttraumatic stress disorder (PTSD) and the mortality associated with OUD may be exacerbated in patients with PTSD. Medication-assisted treatment (MAT) for OUD has become standard of care for OUD and has been shown to reduce mortality. However, there has been little study of MAT and mortality in patients with PTSD and OUD. Methods: We conducted a retrospective cohort study in U.S. veterans who had newly engaged in PTSD treatment, were diagnosed with OUD and were provided MAT for at least one day between 2004 and 2013. We assessed mortality for one year following the index diagnosis date. We calculated all-cause mortality as well as death by external cause, overdose plus suicide, overdose, and suicide rates per 100,000. We used hazard ratios (HR) and 95% confidence intervals (CI) to compare death rates between patients with high versus low adherence to MAT. We evaluated the impact of high versus low exposure to general substance abuse care. We considered a confidence interval that did not cross one to be significant. Results: A total of 5,901 patients met inclusion criteria. Most patients were men and the average age was 43.3 years (SD = 13.8). The all-cause mortality rate was 1,370 per 100,000 patients. High adherence to MAT resulted in a non-significant, decreased risk for death due to all-cause (HR = 0.73, 95% CI [0.47, 1.13]), external cause (HR = 0.71, 95% CI [0.38, 1.35]), and overdose or suicide (HR = 0.66, 95% CI [0.33, 1.35]). Patients with high exposure (≥ 60 days) to general substance abuse care were significantly less likely to die due to external cause (HR = 0.39, 95% CI [0.18, 0.85]) and overdose or suicide (HR = 0.31, 95% CI [0.12, 0.77]). Conclusions: In patients with PTSD and OUD, improved adherence to MAT and greater exposure to general substance abuse care may result in lower mortality. Studies with longer follow-up and larger sample sizes to assess the impact of MAT on suicide are needed to confirm our findings.

中文翻译：

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具有创伤后应激障碍和阿片类药物使用障碍的全国退伍军人队列中药物辅助治疗服务提供与死亡率之间的关联

摘要目的：阿片类药物使用障碍（OUD）是美国（US）的一个值得注意的问题，并且与死亡率密切相关。创伤后应激障碍 (PTSD) 患者中 OUD 的患病率很高，并且在 PTSD 患者中与 OUD 相关的死亡率可能会加剧。OUD 的药物辅助治疗 (MAT) 已成为 OUD 的标准护理，并已被证明可以降低死亡率。然而，关于 PTSD 和 OUD 患者的 MAT 和死亡率的研究很少。方法：我们对 2004 年至 2013 年间新接受 PTSD 治疗、被诊断为 OUD 并提供至少一天 MAT 的美国退伍军人进行了一项回顾性队列研究。我们评估了指数诊断日期后一年的死亡率。我们计算了全因死亡率以及外因死亡率，过量加自杀，过量和每 100,000 人的自杀率。我们使用风险比 (HR) 和 95% 置信区间 (CI) 来比较 MAT 依从性高与低的患者之间的死亡率。我们评估了高接触和低接触一般药物滥用护理的影响。我们认为没有交叉的置信区间是显着的。结果：共有 5,901 名患者符合纳入标准。大多数患者为男性，平均年龄为 43.3 岁（SD = 13.8）。全因死亡率为每 100,000 名患者 1,370 人。对 MAT 的高依从性导致因全因 (HR = 0.73, 95% CI [0.47, 1.13])、外因 (HR = 0.71, 95% CI [0.38, 1.35]) 导致的死亡风险不显着降低)，以及用药过量或自杀（HR = 0.66, 95% CI [0.33, 1.35]）。高暴露（≥ 60 天）一般药物滥用护理的患者因外部原因（HR = 0.39，95% CI [0.18, 0.85]）和药物过量或自杀（HR = 0.31，95% CI）死亡的可能性显着降低[0.12, 0.77])。结论：在 PTSD 和 OUD 患者中，改善对 MAT 的依从性和更多地接触一般药物滥用治疗可能会导致较低的死亡率。需要更长时间的随访和更大样本量的研究来评估 MAT 对自杀的影响，以证实我们的发现。