Assessing the Safety and Effectiveness of Opioid Tapering in Large Health Systems

评估大型卫生系统中阿片类药物逐渐减少的安全性和有效性

基本信息

批准号：
10312037
负责人：
Ingrid A Binswanger
金额：
$ 70.88万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-03-15 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10312037
关键词：
Address Adopted Adverse effects Affect Age Award Behavior Centers for Disease Control and Prevention (U.S.)Chronic Clinical Colorado Complex Data Depression and Suicide Development Dose Effectiveness Electronic Health Record Ethnic Origin Fentanyl Fright Goals Guidelines Health Services Health behavior Health system Heroin Individual Information Systems Lead Link Longitudinal cohort Longitudinal cohort study Medical Medical Records Mental Depression Mental disorders Methodology Methods Modeling Opioid Opioid Analgesics Outcome Overdose Pain Pain management Pathway interactions Patient Outcomes Assessments Patients Pattern Persons Pharmaceutical Preparations Physicians Policies Provider Race Research Risk Risk Estimate Risk Factors Safety Sample Size Substance Use Disorder Suicide Techniques United States Wisconsin Withdrawal base chronic pain chronic pain patient cohort data resource effectiveness evaluation epidemiology study follow-up health care service utilization illicit opioid innovation novel opioid epidemic opioid mortality opioid overdose opioid tapering opioid therapy opioid use disorder overdose death overdose risk prescription opioid provider behavior provider factors response rural area sex sociodemographics substance use suicidal risk systematic review urban area

项目摘要

PROJECT ABSTRACT The United States is amidst a rapidly evolving opioid epidemic, with more than 200,000 deaths from opioid pain reliever overdoses since 1999. In 2016, the Centers for Disease Control and Prevention issued guidelines on the management of opioid therapy in chronic pain. These guidelines emphasized tapering opioids among individuals prescribed high-dose opioid therapy or with other overdose risk factors. While physicians are increasingly reducing or discontinuing (tapering) patients prescribed chronic opioid therapy, evidence to support the effectiveness and safety of tapering practices is lacking. While tapering opioids represents a reasonable approach to reduce the risk of overdose, there are also concerns that tapering opioids may lead to increased pain and withdrawal, prompting some individuals to seek illicit opioids such as heroin, paradoxically increasing their risk for overdose. The overall goal of this project is to conduct a longitudinal cohort study to determine the effectiveness and safety of opioid tapering in large health systems. We will leverage a data system (Pathways to Opioid Safety Datalink [POSD]) that contains linked data on more than 2.5 million people in rural and urban areas in Colorado and Wisconsin. Using the POSD data system, we will examine opioid tapering practices in a cohort of approximately 48,000 patients prescribed chronic opioid therapy from 2012 to 2020. We will employ novel analytic techniques to identify distinct tapering practices, such as gradual dose reduction, rapid dose reduction, dose discontinuation followed by re-initiation, and sustained dose discontinuation. We will then determine which patient and provider factors and behaviors are associated with opioid tapering. In the cohort, effectiveness and safety will be examined by comparing clinically important outcomes across tapering practices. Outcomes will include overdose, suicide, opioid use disorder, and health care utilization for pain and withdrawal. Lastly, we will develop and apply novel methods to minimize bias from loss to follow-up and misclassification of exposure and outcomes, including quantitative bias analysis, probabilistic bias analysis, and propensity scores. Our findings will have the potential to influence national clinical guidelines on opioid management. Our proposed research approach also represents a new paradigm for how to rigorously assess important opioid prescribing and substance use outcomes using complex health services data.

项目摘要美国正处于迅速发展的阿片类药物流行中，阿片类药物的死亡人数超过200,000 自1999年以来的止痛药过量。2016年，疾病控制与预防中心发布了指南关于慢性疼痛的阿片类药物治疗的管理。这些准则强调了逐渐变细的阿片类药物个人开了大剂量阿片类药物疗法或其他过量危险因素。虽然医生是越来越减少或终止（锥度）患者开处方慢性阿片类药物治疗，证据缺乏支持逐渐减少实践的有效性和安全性。逐渐变细的阿片类药物代表降低过量风险的合理方法，也有人担心逐渐变细的阿片类药物可能导致增加疼痛和戒断，促使某些人寻求非法阿片类药物（例如海洛因）增加他们过量的风险。该项目的总体目标是进行纵向队列研究，以确定有效性和大型卫生系统中阿片类药物的安全性。我们将利用数据系统（阿片类药物安全途径 Datalink [POSD]）包含有关在农村和城市地区有250万人的链接数据科罗拉多州和威斯康星州。使用POSD数据系统，我们将检查队列中的阿片类药物逐渐减少的实践从2012年到2020年，大约有48,000名患者处方了慢性阿片类药物疗法。我们将采用新颖分析技术以识别不同的逐渐减少实践，例如逐渐减少剂量，快速剂量减少，停用剂量，然后重新生效，并持续停用剂量。然后我们将确定哪些患者和提供者的因素和行为与阿片类药物逐渐减少有关。在队列中，将通过比较逐渐变细的临床重要结果来检查有效性和安全性实践。结果将包括过量，自杀，阿片类药物使用障碍以及疼痛和医疗保健利用提取。最后，我们将开发和采用新颖的方法来最大程度地减少从损失到随访和暴露和结果的错误分类，包括定量偏见分析，概率偏见分析，和倾向得分。我们的发现将有可能影响阿片类药物管理的国家临床指南。我们的拟议的研究方法还代表了如何严格评估重要阿片类药物的新范式使用复杂的保健服务数据处方和物质使用结果。

项目成果

期刊论文数量（6）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Opioid Overdose Risk Following Hospital Discharge Among Individuals Prescribed Long-Term Opioid Therapy: a Risk Interval Analysis.

DOI：
10.1007/s11606-022-08014-1
发表时间：
2023-08
期刊：
JOURNAL OF GENERAL INTERNAL MEDICINE
影响因子：
5.7
作者：
Lyden, Jennifer R.;Xu, Stanley;Narwaney, Komal J.;Glanz, Jason M.;Binswanger, Ingrid A.
通讯作者：
Binswanger, Ingrid A.

Update of a Multivariable Opioid Overdose Risk Prediction Model to Enhance Clinical Care for Long-term Opioid Therapy Patients.

更新多变量阿片类药物过量风险预测模型，以加强对长期阿片类药物治疗患者的临床护理。

DOI：
10.1007/s11606-023-08149-9
发表时间：
2023
期刊：
Journal of general internal medicine
影响因子：
5.7
作者：
Nguyen,AnhP;Glanz,JasonM;Narwaney,KomalJ;Zeng,Chan;Wright,Leslie;Fairbairn,LaneM;Binswanger,IngridA
通讯作者：
Binswanger,IngridA

An individual segmented trajectory approach for identifying opioid use patterns using longitudinal dispensing data.

使用纵向配药数据识别阿片类药物使用模式的单独分段轨迹方法。

DOI：
10.1002/pds.5708
发表时间：
2024
期刊：
Pharmacoepidemiology and drug safety
影响因子：
2.6
作者：
Xu,Stanley;Narwaney,KomalJ;Nguyen,AnhP;Binswanger,IngridA;McClure,DavidL;Glanz,JasonM
通讯作者：
Glanz,JasonM

Opioid Use Disorder Treatment Initiation and Continuation: a Qualitative Study of Patients Who Received Addiction Consultation and Hospital-Based Providers.

DOI：
10.1007/s11606-021-07305-3
发表时间：
2022-08
期刊：
Journal of general internal medicine
影响因子：
5.7
作者：
Calcaterra SL;Lockhart S;Callister C;Hoover K;Binswanger IA
通讯作者：
Binswanger IA

Opioid Dose Trajectories and Associations With Mortality, Opioid Use Disorder, Continued Opioid Therapy, and Health Plan Disenrollment.

DOI：
10.1001/jamanetworkopen.2022.34671
发表时间：
2022-10-03
期刊：
JAMA NETWORK OPEN
影响因子：
13.8
作者：
Binswanger, Ingrid A.;Shetterly, Susan M.;Xu, Stanley;Narwaney, Komal J.;McClure, David L.;Rinehart, Deborah J.;Nguyen, Anh P.;Glanz, Jason M.
通讯作者：
Glanz, Jason M.