The impact of chronic pain on buprenorphine treatment retention among patients with opioid use disorder.

慢性疼痛对阿片类药物使用障碍患者丁丙诺啡治疗保留的影响。

• 批准号: 10202541
• 负责人: Li-Tzy Wu
• 金额: $ 8.05万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10202541
• 关键词: Address; Adherence; Affect; Aftercare; Buprenorphine; Caring; Chronic; Clinical; Communities; Cox Proportional Hazards Models; Data; Databases; Dose; Electronic Health Record; Future; Goals; Growth; Health Care Costs; Healthcare Systems; Hyperalgesia; Individual; Lead; Literature; Maintenance Therapy; Measures; Medical; Methadone; Modeling; Morbidity - disease rate; Opioid; Opioid agonist; Outcome; Overdose; Pain; Pain management; Patients; Pattern; Persistent pain; Prevalence; Provider; Public Health; Relapse; Reporting; Research; Resources; Risk; Risk Factors; Safety; Sample Size; Specificity; Statistical Models; Testing; Time; Treatment outcome; Withdrawal; base; buprenorphine treatment; chronic pain; chronic painful condition; comorbidity; cost; craving; effective therapy; health care service utilization; improved; improved outcome; innovation; insight; methadone treatment; mortality; negative affect; non-cancer chronic pain; opioid agonist therapy; opioid epidemic; opioid use; opioid use disorder; premature; retention rate; secondary analysis; social stigma; treatment strategy

Abstract A critical approach to reducing the national epidemic of opioid-related morbidity and mortality includes maximizing retention rates of opioid agonist therapy (OAT) among individuals with OUD. In particular, OAT using buprenorphine, compared to methadone, may be a suitable starting point for many patients with OUD given its relatively broader safety profile (e.g., lower likelihood of overdose), and increased accessibility and lower associated stigma given that it can be prescribed in office-based medical settings. Nevertheless, among the fraction that do utilize buprenorphine, rates of long-term treatment retention, which are crucial to facilitating best outcomes, are low. Thus, a better understanding of the barriers to sufficient buprenorphine treatment retention are needed in order to inform efforts at optimizing current practice of an effective treatment. One factor common among many patients with OUD that may negatively affect buprenorphine treatment retention is the co-occurring presence of chronic non-cancer pain (CNCP). Current research shows that up to approximately two-thirds of patients with OUD in medical settings, for whom buprenorphine treatment could be applicable, have a co-occurring CNCP condition. However, despite the prevalence of CNCP among patients with OUD, remarkably little is known about its impact on buprenorphine treatment retention. The present R03 proposal will address this gap in the literature through secondary analysis of a large electronic health record database of patients receiving buprenorphine treatment for OUD. The overall goal of this application is to better understand how CNCP may operate as a risk factor for lower buprenorphine retention, and in turn, how buprenorphine treatment can be optimized to improve retention outcomes among patients with co-occurring OUD and CNCP. Specifically, we will first determine the extent to which the impact of CNCP on treatment retention depends on uncontrolled pain during treatment characterized via multi-level growth curve modeling. To supplement these findings, we will conduct retrospective chart reviews to identify the extent to which ongoing pain vs. other reasons were reported for premature treatment discontinuation. Reasons will also be identified by empirically-defined buprenorphine adherence trajectory groups to indicate temporal specificity of discontinuation reasons. Furthermore, we aim to elucidate the association between buprenorphine dose and treatment retention among patients with co-occurring OUD and CNCP, which may represent a modifiable factor that could be targeted to improve retention. Together, the findings from this research may inform targeted efforts to enhance the clinical impact of an already existing treatment for OUD in the face of a rapidly increasing opioid epidemic, which could ultimately lead to greater reductions in opioid-related morbidity and mortality and costly healthcare utilization.

抽象的 减少全国阿片类药物相关发病率和死亡率流行的关键方法包括 最大限度地提高 OUD 患者阿片类激动剂治疗 (OAT) 的保留率。特别是燕麦 与美沙酮相比，使用丁丙诺啡可能是许多 OUD 患者的合适起点 鉴于其相对更广泛的安全性（例如，服药过量的可能性较低）以及增加的可及性和 鉴于它可以在办公室医疗环境中开出处方，因此相关的耻辱感较低。尽管如此，其中 使用丁丙诺啡的比例，长期治疗保留率，这对于促进治疗至关重要 最好的结果，是低的。因此，更好地了解充分丁丙诺啡治疗的障碍 需要保留这些信息，以便为优化当前有效治疗实践的努力提供信息。一 许多 OUD 患者中可能对丁丙诺啡治疗保留产生负面影响的常见因素是 同时存在慢性非癌性疼痛 (CNCP)。目前的研究表明，最多 大约三分之二的 OUD 患者在医疗机构中可以接受丁丙诺啡治疗 适用，具有同时发生的 CNCP 条件。然而，尽管 CNCP 在患者中普遍存在 对于 OUD，人们对其对丁丙诺啡治疗保留的影响知之甚少。现在的R03 提案将通过对大型电子健康记录进行二次分析来解决文献中的这一空白 接受丁丙诺啡治疗 OUD 的患者数据库。该应用程序的总体目标是更好地 了解 CNCP 如何作为丁丙诺啡保留率降低的风险因素，以及反过来又如何 可以优化丁丙诺啡治疗，以改善同时发生的患者的保留结果 OUD 和 CNCP。具体来说，我们首先要确定CNCP对治疗的影响程度 保留取决于治疗期间不受控制的疼痛，通过多级生长曲线建模来表征。 为了补充这些发现，我们将进行回顾性图表审查，以确定在多大程度上 据报告，持续疼痛与其他原因导致过早停止治疗。原因也会是 通过经验定义的丁丙诺啡依从轨迹组来识别，以指示时间特异性 停产原因。此外，我们的目的是阐明丁丙诺啡剂量与 同时发生 OUD 和 CNCP 的患者保留治疗，这可能代表一种可修改的 可以作为提高保留率的目标因素。总之，这项研究的结果可能会提供信息 面对快速发展的情况，有针对性地努力增强现有 OUD 治疗的临床影响 阿片类药物流行病的增加，最终可能导致阿片类药物相关发病率的进一步下降 死亡率和昂贵的医疗保健利用。