Objective:

The co-occurrence of unhealthy alcohol use and opioid misuse is high and associated with increased rates of overdose, emergency health care utilization, and death. The current study examined whether receipt of an alcohol-related brief intervention is associated with reduced risk of negative downstream opioid-related outcomes.

Methods:

This retrospective cohort study included all VISN-6 Veterans Affairs (VA) patients with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening results (N=492,748) from 2014 to 2019. Logistic regression was used to examine the association between documentation of an alcohol-related brief intervention and probability of a new 1) opioid prescription, 2) opioid use disorder (OUD) diagnosis, or 3) opioid-related hospitalization in the following year, controlling for demographic and clinical covariates.

Results:

Of the veterans, 13% (N=63,804) had “positive” AUDIT-C screen results. Of those, 72% (N=46,216) had a documented alcohol-related brief intervention. Within 1 year, 8.5% (N=5,430) had a new opioid prescription, 1.1% (N=698) had a new OUD diagnosis, and 0.8% (N=499) had a new opioid-related hospitalization. In adjusted models, veterans with positive AUDIT-C screen results who did not receive an alcohol-related brief intervention had higher odds of new opioid prescriptions (adjusted odds ratio [OR]=1.10, 95% CI=1.03-1.17) and new OUD diagnoses (adjusted OR=1.19, 95% CI=1.02-1.40), while new opioid-related hospitalizations (adjusted OR=1.19, 95% CI=0.99-1.44) were higher although not statistically significant. Removal of medications for OUD (MOUD) did not impact associations. All outcomes were significantly associated with an alcohol-related brief intervention in unadjusted models.

Conclusions:

The VA’s standard alcohol-related brief intervention is associated with subsequent lower odds of a new opioid prescription or a new OUD diagnosis. Results suggest a reduction in a cascade of new opioid-related outcomes from prescriptions through hospitalizations.

中文翻译：

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初级保健提供的与酒精相关的短暂干预与随后的阿片类药物相关结果之间的关联

客观的：

不健康的饮酒和阿片类药物滥用的同时发生率很高，并且与过量用药、紧急医疗保健利用和死亡的发生率增加有关。目前的研究探讨了接受与酒精相关的短暂干预是否与降低下游阿片类药物相关不良结果的风险相关。

方法：

这项回顾性队列研究包括 2014 年至 2019 年所有具有酒精使用障碍识别测试-消费 (AUDIT-C) 筛查结果的 VISN-6 退伍军人事务部 (VA) 患者 (N=492,748)。使用逻辑回归来检查记录之间的关联与酒精相关的短暂干预的可能性以及新的 1) 阿片类药物处方、2) 阿片类药物使用障碍 (OUD) 诊断或 3) 次年阿片类药物相关住院的可能性，控制人口和临床协变量。

结果：

在退伍军人中，13% (N=63,804) 的 AUDIT-C 筛查结果为“阳性”。其中，72%（N=46,216）有过与酒精相关的简短干预记录。 1 年内，8.5% (N=5,430) 的人开出了新的阿片类药物处方，1.1% (N=698) 的人进行了新的 OUD 诊断，0.8% (N=499) 的人进行了新的阿片类药物相关住院治疗。在调整后的模型中，AUDIT-C 筛查结果呈阳性且未接受与酒精相关的短暂干预的退伍军人有更高的几率开出新的阿片类药物处方（调整后的比值比 [OR]=1.10，95% CI=1.03-1.17）和新的 OUD诊断（调整后 OR=1.19，95% CI=1.02-1.40），而新阿片类药物相关住院（调整后 OR=1.19，95% CI=0.99-1.44）较高，但不具有统计学意义。去除 OUD (MOUD) 药物不会影响关联。所有结果均与未调整模型中与酒精相关的短暂干预显着相关。

结论：

退伍军人管理局的标准与酒精相关的简短干预与随后新的阿片类药物处方或新的 OUD 诊断的可能性较低有关。结果表明，从处方到住院治疗，一系列新的阿片类药物相关后果有所减少。