臺灣鎮靜安眠藥、止痛藥及興奮劑之處方藥非醫療使用與自殺意念之關聯:2018全國物質使用調查

Abstract

研究背景：自殺是重要的公共衛生議題，並且物質使用為重要的危險因子之一。由於處方藥使用及非醫療使用的盛行率日益上升，其與自殺的關聯也逐漸受到關注。然而，目前未有研究探討在不同族群（青少年、成人）中，常見處方藥（鎮靜安眠藥、止痛藥、興奮劑）在不同使用情形（僅醫療使用、非醫療使用）與自殺風險之關聯。 研究目的：本研究旨在利用臺灣全國代表性之樣本，來探討青少年與成人，在鎮靜安眠藥、止痛藥、興奮劑三項處方藥的不同使用情形（僅醫療使用、非醫療使用），與自殺意念之間的關聯性。 研究方法：本研究使用「2018全國物質使用調查」進行分析，總樣本數共計18,626名，完訪率為64.6%。其中青少年樣本為12-17歲，樣本數3,598名、成人樣本為18-64歲，樣本數15,028名。問卷內容包含鎮靜安眠藥、止痛藥、興奮劑的處方藥使用經驗、自殺意念及社會人口學變項、其他物質使用經驗、憂鬱狀況的測量。本研究使用多變量羅吉斯迴歸，並分階段校正社會人口學變項、其他物質使用經驗、與憂鬱狀況，來分別探討青少年及成人其在鎮靜安眠藥、止痛藥、興奮劑的不同處方藥使用情形與自殺意念之關聯。 結果：青少年其鎮靜安眠藥、止痛藥、興奮劑的僅醫療與非醫療使用並不常見（盛行率1%或以下），並在校正社會人口學變項、其他物質使用、與憂鬱狀況後，皆未發現與自殺意念有關聯。而成人其鎮靜安眠藥、止痛藥、興奮劑的僅醫療與非醫療使用盛行率則在0.05%-4.93%之間。經校正後，鎮靜安眠藥（校正後勝算比=2.18，95%信賴區間1.46-3.24）、止痛藥（校正後勝算比=1.86，95%信賴區間1.08-3.20）、興奮劑（校正後勝算比=8.63，95%信賴區間2.30-32.40）的僅醫療使用，及興奮劑的非醫療使用（校正後勝算比=6.61，95%信賴區間1.68-26.10）與自殺意念顯著相關。 結論：針對成年之鎮靜安眠藥、止痛藥、興奮劑處方藥使用者，應考量其是否需進行自殺風險評估。

Background: Suicide is a significant public health issue, and substance use is consistently identified as a risk factor of suicide. There are recent concerns about the increasing prevalence of prescription drug use and misuse and their possible associations with suicide risk. However, no studies have investigated the association between suicide risk and the use patterns (medical use only [MUO] vs nonmedical use [NMU]) of common prescription drugs (sedatives/hypnotics, analgesics, and stimulants) in different populations (adolescents vs adults). Aim: To investigate the association of different use patterns (MUO vs NMU) of prescription sedatives/hypnotics, analgesics, and stimulants with suicide ideation in adolescents and adults in a national representative sample in Taiwan. Methods: Data were extracted from the 2018 National Survey of Substance Use, which recruited 18,626 participants with a response rate of 64.6%. Among them, 3,598 were adolescents aged 12-17 years, and 15,028 were adults aged 18-64 years. Participants reported their use of prescription sedatives/hypnotics, analgesics, and stimulants along with suicide ideation, socio-demographic characteristics, other substance use experiences, and depression. Multivariable logistic regression with stepwise adjustment of socio-demographic characteristics, other substance use, and depression was used to examine the association between the use patterns of prescription drugs and suicide ideation in adolescents and adults. Results: The MUO or NMU of prescription sedatives/hypnotics, analgesics, or stimulants was uncommon (1% or less) in adolescents and was not associated with suicide ideation after adjusting for socio-demographic variables, substance use, and depression. In adults, the corresponding prevalence ranged 0.05%-4.93%. The MUO of prescription sedatives/hypnotics (adjusted odds ratio [aOR]=2.18, 95% confidence intervals [CI] 1.46-3.24), analgesics (aOR=1.86, 95% CI 1.08-3.20), and stimulants (aOR=8.63, 95% CI 2.30-32.40), and the NMU of prescription stimulants (aOR=6.61, 95% CI 1.68-26.10) were associated with suicide ideation in adults. Conclusion: Risk assessment of suicide should be considered among adult users of prescription sedatives/hypnotics, analgesics, and stimulants.