Trends and racial/ethnic differences in opioid prescribing safety and use of nonpharmacologic treatments for chronic pain in adults with co-occurring opioid use disorder

患有并发阿片类药物使用障碍的成人慢性疼痛的阿片类药物处方安全性和非药物治疗使用的趋势和种族/民族差异

• 批准号: 10666622
• 负责人: Patience Moyo Dow
• 金额: $ 9.66万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-04-03
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10666622
• 关键词: Address; Adult; Attention; Benzodiazepines; Caring; Categories; Centers for Disease Control and Prevention (U.S.); Climate; Clinical; Clinical Practice Guideline; Data; Disparity; Enrollment; Equity; Evidence based treatment; Future; Goals; Guidelines; Health; Health Insurance; Inpatients; Intervention; Medicare; Minority; Morbidity - disease rate; Naloxone; Opioid; Outcome; Outpatients; Pain; Pain management; Persons; Policies; Prevention Guidelines; Public Health; Recommendation; Research; Risk; Safety; Sampling; Source; Specialist; Subgroup; Time; addiction; chronic pain; chronic pain management; chronic pain patient; comorbidity; disorder risk; disparity reduction; dosage; ethnic difference; ethnic disparity; ethnic minority; health disparity; improved; mortality; non-drug; non-opioid analgesic; nondrug therapy; opioid policy; opioid use disorder; pharmacologic; prescription opioid; racial difference; racial disparity; racial minority; treatment disparity; treatment pattern; trend

In the climate of increased opioid-related morbidity and mortality in the U.S., the safe, effective and comprehensive management of chronic pain is critically important. People with comorbid chronic pain and OUD and racial and ethnic minorities deserve specific attention due to their potential under-treatment of pain and OUD, and elevated risk of adverse health outcomes. In 2016, the Centers for Disease Control and Prevention (CDC) released a prominent clinical practice guideline that emphasizes non-opioid and non-drug alternatives for pain management, and recommends safer prescribing practices if opioids are prescribed to treat chronic pain. An examination of chronic pain treatment patterns over time and in vulnerable subgroups of minorities and people with co-occurring OUD is needed to understand and address health disparities in the delivery of guideline concordant treatment for chronic pain. Using 2015 to 2018 Medicare enrollment data combined with inpatient, outpatient and prescription claims data from a 20% national sample, the proposed research aims to: (1) assess racial and ethnic disparities in the types of chronic pain treatments provided to people with comorbid OUD, and (2) evaluate whether the implementation of the CDC guideline influenced racial/ethnic disparities in the treatment of chronic pain for those with OUD. We will categorize pain treatments as pharmacologic, non-pharmacologic, and combination of pharmacologic and non-pharmacologic. Among those prescribed opioids, we will assess the guideline concordance of prescribing as it relates to opioid dosage and concurrent benzodiazepine prescriptions. We hypothesize that racial/ethnic minorities with OUD are less likely to receive guideline concordant opioid management and non-drug therapy than White chronic pain patients with OUD. We further anticipate worsened disparities in chronic pain treatment following release of the CDC opioid guideline. If confirmed, we will explore potential sources of disparities (e.g., co-prescribing of naloxone, involvement of pain and addiction specialists) that could inform interventions to improve chronic pain treatment in those with cooccurring OUD. The long-term goal of this research is to characterize and reduce disparities in receipt of recommended standards of care and evidence-based treatment for people with co-occurring chronic pain and OUD. Our findings will provide much needed evidence for more effective and equitable public health and health insurance policy, and can inform future clinical guidelines.

在美国与阿片类药物相关的发病率和死亡率增加的气候下，安全，有效和 慢性疼痛的全面管理至关重要。患有合并症的人慢性疼痛和 奥德，种族和少数族裔应特别关注，因为他们的潜力不足 疼痛和OUD，以及不良健康结果的风险升高。 2016年，疾病控制中心 预防（CDC）发布了一项著名的临床实践指南，该指南强调非阿片类药物和 非药物管理的替代方案，并建议如果阿片类药物为 规定治疗慢性疼痛。检查慢性疼痛治疗模式随着时间和时间的检查 少数民族和具有同时发生OUD的人的脆弱亚组是理解和 解决针对慢性疼痛的准则一致性治疗方面的健康差异。使用2015年 2018 Medicare注册数据与住院，门诊和处方索赔相结合。 20％的国家样本，拟议的研究目的是：（1）评估类型的种族和种族差异 向患有合并OUD的人提供的慢性疼痛治疗以及（2）评估是否是 CDC指南的实施影响了慢性疼痛治疗的种族/种族差异 对于那些有Oud的人。我们将将疼痛治疗归类为药理学，非药物和 药理学和非药物的组合。在那些处方的阿片类药物中，我们将评估 处方的指南一致性与阿片类药物剂量和并发苯二氮卓类药物有关 处方。我们假设拥有OUD的种族/族裔少数民族不太可能获得指南 与白色慢性疼痛患者相比，一致的阿片类药物管理和非药物治疗。我们 进一步预期CDC阿片类药物释放后慢性疼痛治疗的差异恶化 指南。如果得到确认，我们将探索潜在的差异来源（例如，纳洛酮的共同处方， 疼痛和成瘾专家的参与）可以告知干预措施以改善慢性疼痛 与同时发生的OUD的治疗。这项研究的长期目标是表征和 减少收到推荐的护理标准和对人的证据治疗的差异 同时出现的慢性疼痛和OUD。我们的发现将为更多证据提供更多的证据 有效，公平的公共卫生和健康保险政策，可以为未来的临床准则提供信息。