Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration
Autor: | Chandra Prakash Gyawali, Gregory S. Sayuk, R. A. Rosenheck, Britt M. Gott, Billy D. Nix, Navya D. Kanuri |
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Rok vydání: | 2018 |
Předmět: |
Adult
Male medicine.medical_specialty Gastrointestinal Diseases Veterans Health Comorbidity Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Pharmacology (medical) 030212 general & internal medicine Practice Patterns Physicians' Medical prescription Adverse effect health care economics and organizations Aged Veterans Aged 80 and over Psychotropic Drugs Hepatology business.industry Gastroenterology Emergency department Middle Aged medicine.disease United States Abdominal Pain Analgesics Opioid Substance abuse United States Department of Veterans Affairs Medically Unexplained Symptoms Relative risk Female 030211 gastroenterology & hepatology Diagnosis code business Cohort study |
Zdroj: | Alimentary Pharmacology & Therapeutics. 47:784-791 |
ISSN: | 0269-2813 |
DOI: | 10.1111/apt.14503 |
Popis: | Background While opioid prescriptions have increased alarmingly in the United States (US), their use for unexplained chronic gastrointestinal (GI) pain (eg, irritable bowel syndrome) carries an especially high risk for adverse effects and questionable benefit. Aim To compare opioid use among US veterans with structural GI diagnoses (SGID) and those with unexplained GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have no accepted role. Methods Veterans Health Administration (VHA) administrative data from fiscal year 2012 were used to identify veterans with diagnostic codes recorded for SGID and FGID. This cohort study examined VHA pharmacy data to compare groups receiving ≥ 1 opioid prescription during the year and number of prescriptions filled. Bivariate and multiple logistic regression analyses adjusted for potential confounding factors (demographics, medical diagnoses, social factors) and identified potential mediators (service use, psychiatric comorbidity) of opioid use in these groups. Results A greater proportion of veterans with FGID received an opioid prescription during fiscal year 2012 (36.0% of 272 431) compared to only 28.9% of 1 223 744 in the SGID group (Relative Risk [RR] = 1.25). In multivariate logistic regression, personality disorders and drug abuse (OR 1.23 for each group), recent homelessness (OR 1.22), psychotropic medication fills (OR 1.55) and emergency department encounters (OR 1.21) were independently associated with opioid prescription use. Conclusions Despite the potential for adverse consequences, opioids more often are prescribed for veterans with chronic, unexplained GI symptoms compared to those with structural diagnoses. Psychiatric comorbidities and frequent healthcare encounters mediate some of the opioid use risk. |
Databáze: | OpenAIRE |
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