Multi-level associations between opioid use and overdose: Individual, clinical, and population-based risk factors for fatality

阿片类药物使用与过量之间的多层次关联：个体、临床和人群的死亡危险因素

• 批准号: 10203905
• 负责人: Hillary Samples
• 金额: $ 19.61万
• 依托单位: RUTGERS BIOMEDICAL/HEALTH SCIENCES-RBHS
• 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 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10203905
• 关键词: Accidental Injury; Accounting; Address; Admission activity; Adult; Age; American; Area; Cause of Death; Cessation of life; Characteristics; Clinical; County; Data; Data Files; Data Sources; Death Rate; Development; Development Plans; Disabled Persons; Disadvantaged; Dose; Early Intervention; Education; Eligibility Determination; Enrollment; Ethics; Ethnic Origin; Formulation; Funding; Geography; Goals; Guidelines; Health; Health Resources; Health Services Accessibility; Health Services Research; Health Status; Health system; Healthcare; Healthcare Systems; Hospitals; Improve Access; Income; Individual; Intervention; Knowledge; Life Expectancy; Link; Longitudinal Studies; Measures; Medicaid; Medical; Mental disorders; Mentorship; Methodology; Methods; Minority; Monitor; Morbidity - disease rate; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Pain; Pain management; Pathway interactions; Pattern; Patterns of Care; Pharmaceutical Preparations; Pharmacy facility; Policies; Policy Research; Population; Population Characteristics; Poverty; Practice Guidelines; Prescription opioid overdose; Public Health; Race; Reporting; Research; Research Methodology; Research Personnel; Research Training; Resources; Risk; Risk Factors; Secure; Services; Socioeconomic Factors; Strategic Planning; System; Time; Training; Training Support; Unemployment; Universities; Vulnerable Populations; Work; base; beneficiary; career; career development; chronic pain; clinical care; clinical epidemiology; clinical pain; comorbidity; contextual factors; disability; dosage; effective intervention; geographic difference; health care availability; high risk population; improved; indexing; innovation; mortality; non-cancer chronic pain; novel; opioid epidemic; opioid mortality; opioid overdose; opioid use; opioid use disorder; overdose death; overdose risk; patient population; personalized approach; population based; population health; prescription monitoring program; prescription opioid; prevent; programs; response; rural counties; sex; social; social epidemiology; social structure; sociodemographic factors; sociodemographics; spatial epidemiology; statistics; stem; substance use; tertiary prevention; theories; trend

PROJECT SUMMARY: Over the past two decades, high rates of opioid prescribing have led to widespread opioid use and epidemic levels of adverse opioid-related outcomes. Early interventions focused on reducing opioid prescribing through the development of practice guidelines and implementation of programs and policies to increase prescription opioid management and monitoring. While overall opioid prescribing has declined in recent years and may have contributed to reductions in prescription opioid-involved overdose death rates in 2012 and 2013, the rate has since risen to a new high, comprising 40% of all opioid-related deaths in 2016. Furthermore, prescribing remains elevated in disadvantaged groups and areas, highlighting a need to better understand how individual characteristics intersect with health system and population-level factors in the pathways from opioid use to fatal and non-fatal overdose. Using a multi-level approach, the proposed project examines trajectories from opioid treatment for chronic non-cancer pain to opioid overdose and fatality, accounting for: 1) individual sociodemographic and clinical characteristics (e.g. sex, age, race/ethnicity, comorbidities), 2) opioid treatment patterns (e.g. dosage, duration, formulation), 3) county-level health system (e.g. facilities, services) and population characteristics (e.g. percent poverty, minority, unemployed, disabled), and 4) state-level policies (e.g. Medicaid policies, Prescription Drug Monitoring Programs). Opioid treatment patterns will be assessed using national Medicaid Analytic Extract (MAX) data, adjusting for individual characteristics. Risk of overdose based on individual characteristics and treatment patterns will be assessed using MAX data for medically treated non-fatal opioid overdose and National Death Index (NDI) data for fatal opioid overdose. Overdose outcomes will be further assessed using county-level Area Health Resource File (AHRF) data and state-level policy measures. Contextualizing individual outcomes within wider health care systems and social and geographic settings supports NIDA’s strategic plan to increase the public health impact of research. Additional substantive and methodological training will contribute to the applicant’s long-term goal to develop an independent academic research career and generate and disseminate robust evidence to inform effective interventions to reduce opioid-related morbidity and mortality. The training aims include advanced study and application of: 1) innovative methods to characterize clinical care patterns over time, 2) social and spatial epidemiology theory and methods to study multilevel influences on health, 3) policy drivers of health and health care, and 4) professional development for conducting ethical, independent research. The research and training are supported by an interdisciplinary mentorship team of Columbia University researchers with expertise in substance use and policy research, clinical and spatial epidemiology, and statistics with additional support from external collaborators in health services and policy research methods. This project and career development plan will prepare the applicant to secure R01 funding to extend this line of research.

项目摘要：在过去的二十年中，阿片类药物处方的高比例导致了广泛的 阿片类药物的使用和阿片类药物相关不良后果的流行程度。早期干预措施的重点是减少阿片类药物的使用和不良后果的流行程度。 通过制定实践指南和实施方案和政策来开具阿片类药物处方 加强处方阿片类药物的管理和监测，而阿片类药物的总体处方量有所下降。 近年来，这可能有助于降低处方阿片类药物过量死亡率 2012 年和 2013 年，该比率升至新高，占 2016 年阿片类药物相关死亡总数的 40%。 此外，弱势群体和地区的处方率仍然很高，这凸显出需要更好地 了解个人特征如何与卫生系统和人口层面的因素相交叉 拟议项目采用多层次方法，探讨从阿片类药物使用到致命和非致命过量的途径。 检查从阿片类药物治疗慢性非癌症疼痛到阿片类药物过量和死亡的轨迹， 考虑：1) 个人社会人口统计和临床特征（例如性别、年龄、种族/民族， 合并症），2）阿片类药物治疗模式（例如剂量、持续时间、配方），3）县级卫生系统 （例如设施、服务）和人口特征（例如贫困百分比、少数民族、失业、残疾人）， 4) 州级政策（例如医疗补助政策、处方药监测计划）。 将使用国家医疗补助分析提取 (MAX) 数据评估模式，并根据个人情况进行调整 将根据个人特征和治疗模式评估用药过量的风险。 使用 MAX 数据进行医学治疗的非致命性阿片类药物过量用药，使用国家死亡指数 (NDI) 数据进行致命性治疗 阿片类药物过量将使用县级地区卫生资源档案进一步评估。 (AHRF) 数据和州级政策措施将个人结果纳入更广泛的医疗保健范围内。 系统以及社会和地理环境支持 NIDA 增加公共卫生影响的战略计划 额外的实质性和方法论培训将有助于申请人的长期目标。 发展独立的学术研究事业，并生成和传播强有力的证据来告知 减少阿片类药物相关发病率和死亡率的有效干预措施包括高级培训目标。 研究和应用：1）随着时间的推移描述临床护理模式的创新方法，2）社会和 研究健康多层次影响的空间流行病学理论和方法，3）健康的政策驱动因素 和医疗保健，以及 4) 进行道德、独立研究的专业发展。 和培训由哥伦比亚大学研究人员组成的跨学科指导团队提供支持 物质使用和政策研究、临床和空间流行病学以及统计学方面的专业知识 外部合作者在卫生服务和政策研究方法方面的支持。 开发计划将使申请人做好准备，获得 R01 资金以扩展这一研究领域。