Absence of Brief Intervention Following Positive Alcohol Screen Associated with Increased Opioid-Related Risks within a Year
BACKGROUND:
The co-occurrence of unhealthy alcohol use and opioid misuse is high and associated with increased rates of overdose, emergency healthcare use, and death. Screening and brief intervention (BI) for alcohol use is an intervention for mitigating unhealthy alcohol use with regular surveillance of alcohol consumption in primary care settings. This study used electronic health record (EHR) data to examine the association between primary care-delivered alcohol-related BI and new opioid prescriptions, new opioid use disorder (OUD) diagnosis, or new opioid-related hospitalization in Veterans one year after a positive screen for alcohol use. Participants were VISN 6 Veterans who had an Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening from 2014–2019 (N=492,748).
FINDINGS:
- Thirteen percent (63,804) of Veterans in the sample screened positive for unhealthy alcohol use on the AUDIT-C. Of those, Veterans who did not receive alcohol-related BI had 10% higher odds of obtaining a new opioid prescription within a year, and 19% higher odds of receiving an OUD diagnosis within a year. New opioid-related hospitalizations were also 19% higher, though not statistically significant.
- Of the Veterans in the sample who had a positive AUDIT-C, 72% (46,216) had documented alcohol-related BI, and within one year, 9% (5,430) had a new opioid prescription, 1% (698) had a new OUD diagnosis, and <1% (499) had a new opioid-related hospitalization.
IMPLICATIONS:
- Use of VA’s standard alcohol-related BI suggests a reduction in a cascade of new opioid-related outcomes from prescription through hospitalization.
LIMITATIONS:
- The study did not examine long-term opioid therapy, which is a common measure in the cascade of opioid-related outcomes.
- Despite an initial cohort of almost half a million patients, the rarity of opioid-related hospitalizations may have limited the ability for meaningful effects to reach statistical significance.
- All data were collected from VA’s EHR, and meaningful non-VA data may not be captured.
- The data did not examine potential mechanistic roles of other healthcare or patient factors in the associations found.
AUTHOR/FUNDING INFORMATION:
Dr. Blalock and Mr. Berkowitz are with HSR’s Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT). Dr. Blalock is supported by a VA HSR Career Development Award.
Blalock DV, Berlin SA, Berkowitz T, et al. Associations Between a Primary Care-Delivered Alcohol-Related Brief Intervention and Subsequent Opioid-Related Outcomes. The American Journal of Psychiatry. May 1, 2024;181(5):434-444.
