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: 9027825
• 负责人: Alexander S Bennett
• 金额: $ 41.44万
• 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/9027825
• 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; 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; opioid use; outcome prediction; prescription opioid; prescription opioid misuse; prevent; programs; psychologic; psychosocial; response; social; stressor; substance misuse

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）：最近从伊拉克和阿富汗参战回国的退伍军人代表了弱势群体，他们面临着处方阿片类药物 (PO) 滥用和过量服用的极高风险。目前的研究表明，对于女性、少数族裔、无家可归者和其他社会孤立的退伍军人以及有心理健康问题的人来说，这些风险可能更高。尽管有这些关于特定退伍军人亚群中阿片类药物相关风险聚集的初步发现，但目前人们对这些风险如何随着时间的推移而出现以及什么条件和事件导致这些风险知之甚少。该项目是第一个解决随着时间的推移出现的与阿片类药物相关的风险行为的问题，并跟踪退伍军人重返社会经历影响 PO 和其他药物使用模式的变化维度的项目之一。因此，这项研究将跟踪阿片类药物使用退伍军人的物质使用模式以及他们生活中的其他生理、心理和社会维度，从创伤后应激障碍 (PTSD) 症状、抑郁和疼痛严重程度到社会关系和就业状况。该研究将为过量服用风险行为出现之前的压力源、转折点和物质使用模式提供重要见解，以及确保一些使用阿片类药物的退伍军人安全的保护因素，尽管他们在与疼痛和重返社会的心理社会挑战作斗争。为此，它将调查以下目标： 目标 A：确定退伍军人中阿片类药物相关过量风险的关键背景维度。将对 50 名新退伍军人进行定性访谈，这些退伍军人曾接受处方阿片类药物治疗疼痛，并且至少经历过一次涉及阿片类药物的非致命性过量用药。获得的数据将阐明疼痛、阿片类药物、心理健康问题、生活压力源和用药过量风险之间的关系。这些数据将为目标 B 和 C 的工具设计和改进提供信息。目标 B：确定与退伍军人随着时间的推移进入和摆脱用药过量风险相关的生物、心理和社会因素。该项目将调查 250 名最近使用 PO 的退伍军人，并对他们进行为期两年的跟踪，使用交互式语音应答 (IVR) 技术收集每月数据，以便： 1) 根据文献、现有量表制定用药过量风险行为量表 (ORBS) PO 的异常使用、已知的用药过量风险以及退伍军人中的常见风险（尤其是目标 A 中确定的风险）； 2) 测试有关潜在生物心理社会 (BPS) 与过量风险行为相关的假设。目标 C：确定退伍军人对用药过量风险随时间变化的主观看法，以及这些看法如何影响阿片类药物使用模式变化的机制。对 32 名退伍军人的嵌入子样本进行持续的定性访谈将为目标 B 的研究结果提供重要补充，揭示退伍军人伴随疼痛、心理健康和社会支持变化的主观看法、理解和误解，从而为服用过量的风险。