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 减少阿片类药物相关的发病率和死亡率的国家流行的一种关键方法包括 在患有OUD的个体中，阿片类激动剂治疗（OAT）的保留率最大化。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 鉴于其相对较宽的安全性（例如，过量的可能性较低），可访问性增加和 鉴于可以在基于办公室的医疗环境中开处方的相关污名。尽管如此， 使用丁丙诺啡的分数，长期保留率的率，这对于促进 最好的结果很低。因此，更好地理解了足够丁丙诺啡治疗的障碍 为了为优化当前的有效治疗实践的努力提供信息，需要保留。一 在许多可能对丁丙诺啡治疗保留率负面影响的OUD患者中常见的因素是 慢性非癌症疼痛（CNCP）的同时存在。当前的研究表明 在医疗环境中，大约三分之二的OUD患者可以治疗丁丙诺啡治疗 适用，具有同时发生的CNCP条件。然而，尽管患者中有CNCP的率很高 对于Oud，对其对丁丙诺啡治疗保留率的影响知之甚少。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差距 接受OUD治疗的患者数据库。该应用程序的总体目标是更好 了解CNCP如何作为较低丁丙诺啡保留率的危险因素，然后又如何运作 可以优化丁丙诺啡治疗以改善同时发生的患者的保留效果 Oud和CNCP。具体而言，我们将首先确定CNCP对治疗的影响的程度 保留取决于通过多级生长曲线建模的治疗过程中的不受控制的疼痛。 为了补充这些发现，我们将进行回顾性图表审查，以确定 据报道，持续的疼痛与其他原因有关，以期为过早治疗。原因也将是 通过经验定义的丁丙诺啡依从性轨迹识别，以表明 中止原因。此外，我们旨在阐明丁丙诺啡剂量和 同时发生的OUD和CNCP患者的治疗保留率，这可能代表可修改 可以针对提高保留率的因素。这项研究的发现在一起可能会告知 面对迅速的OUD治疗方法的临床影响的有针对性的努力 增加阿片类药物的流行，最终可能导致阿片类药物相关的发病率和 死亡率和昂贵的医疗保健利用。