Description
- Abstract:
- Background and Aims: The opioid and overdose epidemics have become an increasing concern across the United States, with over 100,000 people dying from overdose in 2021 alone. Chronic pain and/or serious mental illness (SMI) increases risk of opioid use, and opioid use disorder (OUD) can also exacerbate these conditions. Treatment for OUD can be lifesaving, but many lack access. We aimed to characterize how these comorbidities affect 90-day substance use treatment uptake after an emergency department (ED) visit among patients at risk of opioid overdose. Methods: We conducted a cohort study using data from the Navigator Trial, wherein patients presenting to the ED at risk of opioid overdose received a behavioral health intervention. Baseline study data for 648 trial participants were linked to statewide administrative data on substance use disorder (SUD) treatment (including buprenorphine & methadone therapy, residential programs, and entry into other licensed SUD treatment facilities). Records accessed included initiation of a new treatment episode, transfer between programs, and re-enrollment in care. Risk ratios for each exposure of interest (chronic pain and SMI) were estimated with unadjusted and adjusted modified Poisson models (rather than logistic regression to account for the non-rare nature of the outcome). Adjusted models included potential confounders (gender, race/ethnicity, education, monthly income, housing status, childhood trauma, and current health insurance) that were selected a priori based on theoretical directed acyclic graphs (DAGs). In an exploratory post hoc analysis, results were further stratified by baseline treatment status. Results: The mean age of participants was 37 (SD=11); 439 (68%) were male and 446 (69%) had been unhoused in the last six months. Overall, 43% of participants enrolled in treatment within 90 days of the ED visit. Those with SMI were more likely to enroll in treatment than those without (adjusted risk ratio [ARR]=1.24, 95% confidence interval [CI]: 1.01-1.53), although this effect was only among those already accessing some form of treatment at baseline (ARR=1.58, 95% CI: 1.10-2.27). Chronic pain was not associated with 90-day treatment enrollment overall (ARR=1.12, 95% CI: 0.91-1.38) or within baseline treatment subgroups.
- Notes:
- Thesis (M. P. H.)--Brown University, 2023
Citation
Rosenfield, Maayan Naomi,
"Impact of Comorbid Chronic Pain or Mental Illness on Substance Use Treatment Among Cohort of Individuals at High Risk of Opioid Overdose"
(2023).
Epidemiology Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://repository.library.brown.edu/studio/item/bdr:svuejnnw/
