Opioid Misuse and Overdose Risk Patterns among Recent Veterans

最近退伍军人中阿片类药物滥用和过量的风险模式

• 批准号: 8728474
• 负责人: Alexander S Bennett
• 金额: $ 42.29万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8728474
• 关键词: Address; Afghanistan; Alcohol or Other Drugs use; Behavior; Behavioral; Biological; Cessation of life; Conflict (Psychology); Data; Dimensions; Employment Status; Ethnography; Event; Foundations; Future; Health; Home environment; Homelessness; Housing; Intervention; Interview; Iraq; Lead; Learning; Life; Literature; Mental Depression; Mental Health; Methods; Military Personnel; Minority; Occupations; Opioid; Outcome; Overdose; Pain; Pain management; Pattern; Perception; Pharmaceutical Preparations; Physiological; Post-Traumatic Stress Disorders; Research; Risk; Risk Behaviors; Severities; Social support; Surveys; Symptoms; Technology; Testing; Time; Veterans; Voice; Vulnerable Populations; Woman; base; biopsychosocial; combat; depressive symptoms; design; experience; insight; instrument; opioid misuse; prescription opioid; prevent; programs; psychologic; psychosocial; public health relevance; response; social; stressor

DESCRIPTION (provided by applicant): Veterans returning home from recent engagements in Iraq and Afghanistan represent a vulnerable population at disproportionate risk of prescription opioid (PO) misuse and overdose. As current research is demonstrating, these risks are potentially even higher for women, minority, homeless, and otherwise socially isolated veterans, as well as those with mental health concerns. Despite these preliminary findings about the clustering of opioid- related risks among particular veteran subpopulations, very little is currenty known about how these risks emerge over time and what conditions and events precipitate them. This project represents one of the first to address the emergence of opioid-related risk behaviors over time and to track the changing dimensions of veterans' reintegration experiences that impact PO and other substance use patterns. Accordingly, this study will track opioid-using veterans' substance use patterns alongside other physiological, psychological, and social dimensions of their lives, ranging from post-traumatic stress disorder (PTSD) symptoms, depression, and pain severity to social relationships and employment status. The study will provide critical insights into the stressors, turning points, and substance use patterns that precede emergence of overdose risk behaviors and the protective factors that keep some opioid-using veterans safe despite their struggles with pain and the psychosocial challenges of reintegration. To do so, it will investigate the following aims: Aim A: Identify key contextual dimensions of opioid-related overdose risk among veterans. Qualitative interviews will be administered to 50 recent veterans who have received prescription opioids for pain and who have experienced at least one non-fatal overdose involving opioids. The data obtained will illuminate the relationships among pain, opioid medications, mental health concerns, life stressors, and overdose risk. These data will inform instrument design and refinement for Aims B and C. Aim B: Identify biological, psychological and social factors related to veterans' transitions into and out of overdose risk over time. The project will survey 250 PO-using recent veterans and follow them for two years, collecting monthly data using interactive voice response (IVR) technology in order to: 1) Develop an Overdose Risk Behavior Scale (ORBS) based on the literature, existing scales for aberrant PO use, known overdose risks, and common risks among veterans (especially as identified in Aim A); and 2) Test hypotheses regarding potential biopsychosocial (BPS) correlates of overdose risk behavior. Aim C: Identify veterans' subjective perceptions of changes in overdose risk over time and how these contribute to the mechanisms underlying changes in opioid use patterns. Ongoing qualitative interviews with an embedded subsample of 32 veterans will provide an important supplement to the findings from Aim B, revealing veterans' subjective perceptions, understandings and misunderstandings that accompany changes in pain, mental health and social support, thus providing a foundation underlying changes in overdose risk.

描述（由申请人提供）：退伍军人从伊拉克和阿富汗最近参与的退伍军人代表着处方阿片类阿片类药物（PO）滥用和过量的风险的脆弱人群。正如当前的研究所表明的那样，这些风险对于妇女，少数群体，无家可归者或社会孤立的退伍军人以及具有心理健康问题的妇女的风险可能更高。尽管这些关于特定退伍军人亚种群中阿片类药物相关风险聚类的初步发现，但最终知之甚少，这些风险随着时间的推移如何出现，以及哪些条件和事件会导致它们。该项目代表了最早解决阿片类药物相关风险行为的首先问题之一，并跟踪退伍军人的重新融合体验的不断变化，从而影响PO和其他物质使用模式。因此，这项研究将跟踪使用退伍军人的物质使用模式以及其生活的其他生理，心理和社会维度，包括创伤后应激障碍（PTSD）症状，抑郁症，抑郁症和疼痛严重程度到社会关系和就业状况。该研究将提供对压力源，转折点和物质使用模式的关键见解，这些模式在过量风险行为的出现和保护性因素之前，尽管他们在痛苦和重新整合的心理社会挑战方面都在挣扎，但仍能使某些使用阿片类药物的退伍军人保持安全。为此，它将调查以下目的：目标答：确定在退伍军人中阿片类药物相关的过量风险的关键上下文维度。定性访谈将对最近的50名退伍军人进行管理，这些退伍军人因疼痛而接受处方阿片类药物，并且至少经历了一种涉及阿片类药物的非致命过量药物。获得的数据将阐明疼痛，阿片类药物，心理健康问题，生命压力源和过量风险之间的关系。这些数据将为B和C的仪器设计和精炼提供信息。目的B：确定与退伍军人过渡到过量风险的生物学，心理和社会因素随着时间的流逝。该项目将调查250个杀人最近的退伍军人，并跟随他们两年，使用交互式语音响应（IVR）技术收集每月数据，以：1）基于文献的现有量表来开发过量的风险行为量表（ORB），用于使用异常的PO，已知的过量剂量，已知的过量风险以及在退伍军人中（尤其是针对AIM AIM A）的常见风险； 2）关于过量风险行为的潜在生物心理社会（BPS）相关的检验假设。 AIM C：确定退伍军人对过量风险随时间变化的主观看法，以及这些对阿片类药物使用模式的机制的贡献。与32名退伍军人的嵌入式子样本进行的持续定性访谈将为AIM B的发现提供重要的补充，从而揭示了退伍军人的主观看法，理解和误解，这些观念和误解伴随着疼痛，心理健康和社会支持的变化，从而为过量风险的基础提供了基础。