Alcohol, Cannabis, and Opioid Use Disorders, and Disease Burden in an Integrated Health Care System

Abstract

Objectives We examined prevalence of major medical conditions and extent of disease burden among patients with and without substance use disorders (SUDs) in an integrated healthcare system serving 3.8 million members. Methods Medical conditions and SUDs were extracted from electronic health records in 2010. Patients with SUDs (n = 45,461; alcohol, amphetamine, barbiturate, cocaine, hallucinogen, and opioid) and demographically matched patients without SUDs (n = 45,461) were compared on the prevalence of nineteen major medical conditions. Disease burden was measured as a function of 10-year mortality risk using the Charlson Comorbidity Index. P-values were adjusted using Hochberg's correction for multiple-inference testing within each medical condition category. Results The most frequently diagnosed SUDs in 2010 were alcohol (57.6%), cannabis (14.9%), and opioid (12.9%). Patients with these SUDs had higher prevalence of major medical conditions than non-SUD patients (alcohol use disorders—85.3% vs. 55.3%; cannabis use disorders—41.9% vs. 23.0%; and opioid use disorders—44.9% vs. 26.1%; all p < .001). Patients with these SUDs also had higher disease burden than non-SUD patients; patients with opioid use disorders (M = 0.48; SE = 1.46) had particularly high disease burden (M = 0.23; SE = 0.09), (p < .001). Conclusions Common SUDs, particularly opioid use disorders, are associated with substantial disease burden for privately insured individuals without significant impediments to care. This signals the need to explore the full impact SUDs have on the course and outcome of prevalent conditions and initiate enhanced service engagement strategies to improve disease burden.

The neurobiology of addiction

“…Tobacco use also remains prevalent, with 48.7 million current cigarette smokers, of whom 27.8 million smoke daily, and 11.4 million smoke at least a pack per day . Substance abuse disorders exert not only a significant public health burden—individuals with substance use disorders are more likely to suffer from chronic pain, hypertension, injuries, poisonings, and overdose—but they also impose significant economic burdens. Costs associated with substance abuse disorder exceed US$700 billion annually due to crime, lost work productivity, and health care; US$250 billion due to alcohol; and US$300 billion due to tobacco.…”

The role of marijuana use disorder in predicting emergency department and inpatient encounters: A retrospective cohort study

“…Marijuana use is also related to a high risk of respiratory infections and pneumonia (Owen et al, 2014), vascular conditions that raise the risk of cardio/cerebrovascular events, such as stroke and myocardial infarction (Thomas et al, 2014), and an increased risk of lung and digestive track cancers (Tashkin, 2013). Not surprisingly, these medical conditions are even more prominent among those with MUDs and contribute considerably to the burden of disease (Bahorik et al, 2017). Marijuana has also been associated with increased risk of motor vehicle accidents, and other acute health events (Monte et al, 2015; Rogeberg and Elvik, 2016).…”

Alcohol and Drug Use, Pain and Psychiatric Symptoms among Adults Seeking Outpatient Psychiatric Treatment: Latent Class Patterns and Relationship to Health Status

“…This is particularly true for substances other than opioids, although patients often use alcohol or cannabis to address their pain. Relatedly, physical illness is significantly higher among patients with substance use and psychiatric disorders, which presents considerable challenges to successful treatment (Bahorik et al 2017, Smith et al 2014). Thus, patients with multiple comorbid conditions, pain and substance use frequently present for services in mental health settings, and it is important to understand potentially common clinical profiles.…”