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Associations Between a Primary Care-Delivered Alcohol-Related Brief Intervention and Subsequent Opioid-Related
Dan V Blalock1, Sophia A Berlin1, Theodore Berkowitz1
1Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, N.C. (Blalock, Berkowitz, Smith, Grubber); Department of Psychiatry and Behavioral Sciences (Blalock) and Division of General Internal Medicine, Department of Medicine (Smith), Duke University School of Medicine, Durham, N.C.; Institute for Medical Research and Durham Veterans Affairs Health Care System, Durham, N.C. (Berlin); Department of Population Health Sciences, Duke University, Durham, N.C. (Smith); UNC Gillings School of Global Public Health, Chapel Hill (Wright); Center for Clinical Management Research, VA Ann Arbor Healthcare System, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Bachrach); Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Health Care System (Grubber).
Objective:
The co-occurrence of unhealthy alcohol use and opioid misuse is high and associated with increased rates of overdose, emergency health care utilization, and death. The current study examined whether receipt of an alcohol-related brief intervention is associated with reduced risk of negative downstream opioid-related outcomes.
Methods:
This retrospective cohort study included all VISN-6 Veterans Affairs (VA) patients with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening results (N=492,748) from 2014 to 2019. Logistic regression was used to examine the association between documentation of an alcohol-related brief intervention and probability of a new 1) opioid prescription, 2) opioid use disorder (OUD) diagnosis, or 3) opioid-related hospitalization in the following year, controlling for demographic and clinical covariates.
Results:
Of the veterans, 13% (N=63,804) had "positive" AUDIT-C screen results. Of those, 72% (N=46,216) had a documented alcohol-related brief intervention. Within 1 year, 8.5% (N=5,430) had a new opioid prescription, 1.1% (N=698) had a new OUD diagnosis, and 0.8% (N=499) had a new opioid-related hospitalization. In adjusted models, veterans with positive AUDIT-C screen results who did not receive an alcohol-related brief intervention had higher odds of new opioid prescriptions (adjusted odds ratio [OR]=1.10, 95% CI=1.03-1.17) and new OUD diagnoses (adjusted OR=1.19, 95% CI=1.02-1.40), while new opioid-related hospitalizations (adjusted OR=1.19, 95% CI=0.99-1.44) were higher although not statistically significant. Removal of medications for OUD (MOUD) did not impact associations. All outcomes were significantly associated with an alcohol-related brief intervention in unadjusted models.
Conclusions:
The VA's standard alcohol-related brief intervention is associated with subsequent lower odds of a new opioid prescription or a new OUD diagnosis. Results suggest a reduction in a cascade of new opioid-related outcomes from prescriptions through hospitalizations.
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