TY - JOUR
KW - Adult
KW - Ambulatory Care/statistics & numerical data
KW - Buprenorphine/therapeutic use
KW - Cohort Studies
KW - Female
KW - Humans
KW - Male
KW - Methadone/therapeutic use
KW - Middle Aged
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/drug therapy/epidemiology
KW - Retrospective Studies
KW - Substance-Related Disorders/epidemiology
KW - United States
KW - United States Department of Veterans Affairs
KW - Veterans/statistics & numerical data
KW - buprenorphine
KW - Comorbid substance use disorder
KW - medication treatment
KW - Methadone
KW - opioid use disorder
KW - polysubstance
AU - L. A. Lin
AU - A. S. B. Bohnert
AU - F. C. Blow
AU - A. J. Gordon
AU - R. V. Ignacio
AU - H. M. Kim
AU - M. A. Ilgen
A1 - 
AB - AIMS: To understand the role of comorbid substance use disorders (SUDs), or polysubstance use, in the treatment of opioid use disorder (OUD), this study compared patients with OUD only to those with additional SUDs and examined association with OUD treatment receipt. DESIGN, SETTING AND PARTICIPANTS: Retrospective national cohort study of Veterans diagnosed with OUD (n = 65 741) receiving care from the US Veterans Health Administration (VHA) in fiscal year (FY) 2017. MEASUREMENTS: Patient characteristics were compared among those diagnosed with OUD only versus those with one other SUD (OUD + 1 SUD) and with multiple SUDs (OUD + ≥ 2 SUDs). The study examined the relationship between comorbid SUDs and receipt of buprenorphine, methadone and SUD outpatient treatment during 1-year follow-up, adjusting for patient demographic characteristics and clinical conditions. FINDINGS: Among the 65 741 Veterans with OUD in FY 2017, 41.2% had OUD only, 22.9% had OUD + 1 SUD and 35.9% had OUD + ≥ 2 SUDs. Common comorbid SUDs included alcohol use disorder (41.3%), cocaine/stimulant use disorder (30.0%) and cannabis use disorder (22.4%). Adjusting for patient characteristics, patients with OUD + 1 SUD [adjusted odds ratio (aOR) = 0.87, 95% confidence interval (CI) = 0.82-0.93] and patients with OUD +≥ 2 SUDs (aOR = 0.65, 95% CI = 0.61-0.69) had lower odds of receiving buprenorphine compared with OUD only patients. There were also lower odds of receiving methadone for patients with OUD + 1 SUD (aOR = 0.91, 95% CI = 0.86-0.97)and for those with OUD + ≥2 SUDs (aOR = 0.79, 95% CI = 0.74-0.84). Patients with OUD + 1 SUD (aOR = 1.85, 95% CI = 1.77-1.93) and patients with OUD + ≥2 SUDs (aOR = 3.25, 95% CI = 3.103.41) were much more likely to have a SUD clinic visit. CONCLUSIONS: The majority of Veterans in the US Veterans Health Administration diagnosed with opioid use disorder appeared to have at least one comorbid substance use disorder and many have multiple substance use disorders. Despite the higher likelihood of a substance use disorder clinic visit, having a non-opioid substance use disorder is associated with lower likelihood of buprenorphine treatment, suggesting the importance of addressing polysubstance use within efforts to expand treatment for opioid use disorder.
AD - Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.; Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.; Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.; Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.; Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.; Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.; Consulting for Statistics, Computing and Analytics Research (CSCAR), University of Michigan, Ann Arbor, MI, USA.; Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
BT - Addiction (Abingdon, England)
C5 - Opioids and Substance Use; Healthcare Disparities
CP - 1
CY - England
DO - 10.1111/add.15116
IS - 1
JF - Addiction (Abingdon, England)
LA - eng
M1 - Journal Article
N2 - AIMS: To understand the role of comorbid substance use disorders (SUDs), or polysubstance use, in the treatment of opioid use disorder (OUD), this study compared patients with OUD only to those with additional SUDs and examined association with OUD treatment receipt. DESIGN, SETTING AND PARTICIPANTS: Retrospective national cohort study of Veterans diagnosed with OUD (n = 65 741) receiving care from the US Veterans Health Administration (VHA) in fiscal year (FY) 2017. MEASUREMENTS: Patient characteristics were compared among those diagnosed with OUD only versus those with one other SUD (OUD + 1 SUD) and with multiple SUDs (OUD + ≥ 2 SUDs). The study examined the relationship between comorbid SUDs and receipt of buprenorphine, methadone and SUD outpatient treatment during 1-year follow-up, adjusting for patient demographic characteristics and clinical conditions. FINDINGS: Among the 65 741 Veterans with OUD in FY 2017, 41.2% had OUD only, 22.9% had OUD + 1 SUD and 35.9% had OUD + ≥ 2 SUDs. Common comorbid SUDs included alcohol use disorder (41.3%), cocaine/stimulant use disorder (30.0%) and cannabis use disorder (22.4%). Adjusting for patient characteristics, patients with OUD + 1 SUD [adjusted odds ratio (aOR) = 0.87, 95% confidence interval (CI) = 0.82-0.93] and patients with OUD +≥ 2 SUDs (aOR = 0.65, 95% CI = 0.61-0.69) had lower odds of receiving buprenorphine compared with OUD only patients. There were also lower odds of receiving methadone for patients with OUD + 1 SUD (aOR = 0.91, 95% CI = 0.86-0.97)and for those with OUD + ≥2 SUDs (aOR = 0.79, 95% CI = 0.74-0.84). Patients with OUD + 1 SUD (aOR = 1.85, 95% CI = 1.77-1.93) and patients with OUD + ≥2 SUDs (aOR = 3.25, 95% CI = 3.103.41) were much more likely to have a SUD clinic visit. CONCLUSIONS: The majority of Veterans in the US Veterans Health Administration diagnosed with opioid use disorder appeared to have at least one comorbid substance use disorder and many have multiple substance use disorders. Despite the higher likelihood of a substance use disorder clinic visit, having a non-opioid substance use disorder is associated with lower likelihood of buprenorphine treatment, suggesting the importance of addressing polysubstance use within efforts to expand treatment for opioid use disorder.
PB - . This article is a U.S. Government work and is in the public domain in the USA
PP - England
PY - 2021
SN - 1360-0443; 0965-2140
SP - 96
EP - 104
EP - 
T1 - Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration
T2 - Addiction (Abingdon, England)
TI - Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration
U1 - Opioids and Substance Use; Healthcare Disparities
U2 - 32428386
U3 - 10.1111/add.15116
VL - 116
VO - 1360-0443; 0965-2140
Y1 - 2021
Y2 - Jan
ER -