Medication Treatment of Active Opioid Use Disorder in Veterans With Cirrhosis.
Age Factors
Alcoholism
/ complications
Analgesics, Opioid
/ therapeutic use
Buprenorphine
/ therapeutic use
Cohort Studies
Female
Hepatitis C, Chronic
/ complications
Humans
Liver Cirrhosis
/ complications
Liver Cirrhosis, Alcoholic
/ complications
Male
Methadone
/ therapeutic use
Middle Aged
Mortality
Multivariate Analysis
Opiate Substitution Treatment
/ statistics & numerical data
Opioid-Related Disorders
/ complications
Proportional Hazards Models
United States
United States Department of Veterans Affairs
Veterans
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
received:
28
06
2020
accepted:
22
01
2021
pubmed:
4
4
2021
medline:
31
8
2021
entrez:
3
4
2021
Statut:
ppublish
Résumé
Although opioid use disorder (OUD) is common in patients with cirrhosis, it is unclear how medication treatment for OUD (MOUD) is used in this population. We aimed to assess the factors associated with MOUD and mortality in a cohort of Veterans with cirrhosis and OUD. Within the Veterans Health Administration Corporate Data Warehouse, we developed a cohort of Veterans with cirrhosis and active OUD, using 2 outpatient or 1 inpatient International Classification of Diseases, ninth revision codes from 2011 to 2015 to define each condition. We assessed MOUD initiation with methadone or buprenorphine over the 180 days following the first OUD International Classification of Diseases, ninth revision code in the study period. We fit multivariable regression models to assess the association of sociodemographic and clinical factors with receiving MOUD and the associations between MOUD and subsequent clinical outcomes, including new hepatic decompensation and mortality. Among 5,600 Veterans meeting criteria for active OUD and cirrhosis, 722 (13%) were prescribed MOUD over 180 days of follow-up. In multivariable modeling, MOUD was significantly, positively associated with age (adjusted odds ratio [AOR] per year: 1.04, 95% confidence interval (CI): 1.01-1.07), hepatitis C virus (AOR = 2.15, 95% CI = 1.37-3.35), and other substance use disorders (AOR = 1.47, 95% CI = 1.05-2.04) negatively associated with alcohol use disorder (AOR = 0.70, 95% CI = 0.52-0.95), opioid prescription (AOR = 0.51, 95% CI = 0.38-0.70), and schizophrenia (AOR = 0.59, 95% CI = 0.37-0.95). MOUD was not significantly associated with mortality (adjusted hazards ratio = 1.20, 95% CI = 0.95-1.52) or new hepatic decompensation (OR = 0.57, CI = 0.30-1.09). Few Veterans with active OUD and cirrhosis received MOUD, and those with alcohol use disorder, schizophrenia, and previous prescriptions for opioids were least likely to receive these effective therapies.
Identifiants
pubmed: 33811202
doi: 10.14309/ajg.0000000000001228
pii: 00000434-202107000-00015
pmc: PMC8819871
mid: NIHMS1770629
doi:
Substances chimiques
Analgesics, Opioid
0
Buprenorphine
40D3SCR4GZ
Methadone
UC6VBE7V1Z
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1406-1413Subventions
Organisme : AHRQ HHS
ID : K12 HS019461
Pays : United States
Organisme : NIDA NIH HHS
ID : K23 DA048182
Pays : United States
Informations de copyright
Copyright © 2021 by The American College of Gastroenterology.
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