Mentoring Junior Investigators to Tackle the Opioid Epidemic

指导初级研究人员应对阿片类药物流行病

基本信息

批准号：
9888338
负责人：
Joanna L. Starrels
金额：
$ 18.87万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-03-01 至 2024-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9888338
关键词：
AIDS prevention Acupuncture Therapy Address Adherence Adopted Adoption Applications Grants Award Buprenorphine Caring Centers for Disease Control and Prevention (U.S.)Chronic Clinical Cohort Studies Data Data Collection Data Set Development Dose Dropout Effectiveness Effectiveness of Interventions Epidemic Fracture Funding Future Goals Guidelines HIV Health Policy Incidence Individual Intervention Interview Lead Learning Manuscripts Medical Marijuana Mentors Mentorship Methodology Mid-Career Clinical Scientist Award (K24)Nonpharmacologic Therapy Observational Study Opioid Outcome Pain Patient Preferences Patient-Focused Outcomes Patients Pharmaceutical Preparations Physicians Primary Health Care Provider Public Health Quality of life Research Research Infrastructure Research Methodology Research Personnel Resources Risk Testing Training Support Translating Viral Load result Withdrawal Symptom antiretroviral therapy career career development chronic pain chronic pain management chronic pain patient clinical practice cohort comparative effectiveness depressive symptoms evidence base experimental study falls high risk illicit opioid implementation science injection drug use innovation mindfulness meditation opioid epidemic opioid injection opioid tapering opioid use opioid use disorder overdose death overdose risk patient oriented research patient subsets prescription opioid primary care setting programs prospective public health emergency recruit research and development response responsible research conduct risk mitigation sex skills stem tool transmission process

项目摘要

ABSTRACT My overall goal is to advance the evidence needed to stem the opioid epidemic, and to translate the evidence into real-world implementation and effective public health policy. The current opioid epidemic in the US was driven by widespread use of prescription opioids (POs) for chronic pain. In response, guidelines and health policies increasingly promote use of opioid risk mitigation strategies such as PO tapering (reducing the dose or discontinuing POs). However, adoption of opioid risk mitigation strategies is outpacing the evidence, for example, outcomes of PO tapering and optimal strategies for implementing PO tapering in real-world HIV and primary care settings are unknown. PO tapering can have particularly serious implications for HIV control, if tapering causes patients to fall out of HIV care or replace POs with illicit or injected opioid use; but the risks have not been quantified and factors associated with these outcomes have not been described. Given the overall lack of evidence about PO risk mitigation strategies and their implementation and the urgency of addressing the epidemic, it is imperative to expand the capacity of clinician-investigators conducting patient- oriented research on PO use in HIV+ and HIV- individuals. I am a physician who treats chronic pain and opioid use disorder, an investigator focused on judicious PO prescribing for over a decade, and an educator with a strong mentoring track record and exceptional institutional resources to support mentees. This K24 mid-career investigator award will help to expand capacity of clinician investigators in the field by: 1) providing outstanding mentorship to junior investigators focused on PO use in chronic pain, 2) expanding my research in implementation science methodologies to optimize translating evidence into practice, and 3) advancing my development as a leader in translating evidence about PO use into guidelines and health policy. My strong existing research program focused on PO risk mitigation practices for HIV+ and HIV- patients with chronic pain, along with exceptional advisors and institutional resources, will provide a platform for mentoring and expanding my skills. Using my existing study cohorts and new primary data collection including qualitative interviews and a discrete choice experiment, we propose the following new research aims: 1) to examine the positive and negative outcomes of PO tapering among HIV+ and HIV- patients with chronic pain, and 2) to identify patient preferences for different PO tapering strategies among HIV+ and HIV- patients with chronic pain and high-risk PO use. All proposed research will be conducted with mentees and will provide ample opportunities for mentee development in diverse research methods, responsible conduct of research, and preparing manuscripts and grant applications. Findings from the research will inform future interventions and guidelines for PO tapering. Overall, the proposed plans for mentoring, career development, and research will expand capacity to address the opioid epidemic.

抽象的我的总体目标是促进阻止阿片类药物流行所需的证据，并翻译证据进入现实世界实施和有效的公共卫生政策。美国目前的阿片类药物流行是由普遍使用处方阿片类药物（POS）驱动慢性疼痛。作为回应，指南和健康政策越来越多地促进使用阿片类药物的降低风险策略，例如逐渐减少（减少剂量或中止POS）。但是，采用阿片类药物风险缓解策略正在超过证据，因为例如，在现实世界中的艾滋病毒中实施逐渐变细的结果和最佳策略的结果初级保健设置未知。逐渐缩减对艾滋病毒的控制可能特别严重，如果逐渐变细会导致患者退出艾滋病毒护理或用非法或注射阿片类药物的使用代替POS；但是风险尚未量化，与这些结果相关的因素尚未描述。鉴于总体缺乏有关PO风险缓解策略及其实施和紧迫性的证据解决流行病，必须扩大导致患者的临床医生评估者的能力 - 针对艾滋病毒+和艾滋病毒的PO使用的定向研究。我是一名治疗慢性疼痛和阿片类药物的医生使用障碍，一名专注于明智的处方数十多年的调查员，还有一个教育家强大的指导记录和卓越的机构资源来支持受训者。这个K24中期调查员奖将帮助扩大该领域的临床医生调查人员的能力：1）初级调查人员的指导专注于PO在慢性疼痛中使用，2）扩大我的研究实施科学方法论以优化转化证据为实践，以及3）推进我的作为将有关PO使用的证据转化为准则和卫生政策的领导者的发展。我的坚强现有研究计划的重点是艾滋病毒+和艾滋病毒的慢性病患者的PO风险缓解措施痛苦以及卓越的顾问和机构资源将为指导和扩大我的技能。使用我现有的研究队列和新的主要数据收集，包括定性访谈和一个离散选择实验，我们提出以下新研究的目的：1）检查 HIV+和HIV-慢性疼痛患者中PO逐渐变细的阳性和负结果，2）确定患者对HIV+和HIV-慢性患者中不同PO缩减策略的偏好疼痛和高风险PO使用。所有拟议的研究将与受训者一起进行，并将提供充足的在各种研究方法，负责任的研究和准备手稿和赠款申请。研究结果将为未来的干预措施和 PO缩小指南。总体而言，拟议的指导，职业发展和研究计划将扩大能力以解决阿片类药物流行。