Building and Implementing Best Practices for Buprenorphine Initiation in the Setting of Fentanyl Use

在芬太尼使用情况下建立和实施丁丙诺啡起始的最佳实践

基本信息

批准号：
10721763
负责人：
Elenore Bhatraju
金额：
$ 18.8万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-15 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10721763
关键词：
Absence of pain sensation Award Awareness Buprenorphine Caring Certification Cessation of life Clinical Communities Complex Consensus Counseling Country Data Data Collection Dose Effectiveness Enrollment FDA approved Failure Feedback Fentanyl Funding Future Goals Hospitals Individual Inpatients Interview Life Literature Medical center Methadone Methods Morbidity - disease rate Naltrexone Nature Opioid Opioid agonist Outcome Outpatients Patient Care Patients Penetration Persons Pharmaceutical Preparations Phase Physicians Pilot Projects Practice Guidelines Preparation Prevalence Procedures Process Provider Qualitative Methods Qualitative Research Randomized Reaction Research Research Methodology Research Personnel Research Support Research Training Review Literature Risk Rural Safety Secondary to Substance Use Disorder Time Training Treatment Failure Ventilatory Depression Waiting Lists Withdrawal Work addiction career effectiveness/implementation study evidence base experience feasibility testing fentanyl use implementation barriers implementation evaluation implementation facilitators implementation science improved improved outcome innovation lipophilicity medication for opioid use disorder mortality multidisciplinary novel opioid use opioid use disorder overdose death preference provider factors recruit relative effectiveness response safety net tool virtual

项目摘要

PROJECT SUMMARY Morbidity and mortality related to opioid use continue to rise, with fentanyl now the most common opioid involved in overdose death. Despite three FDA approved medications for opioid use disorder (MOUD)—methadone, buprenorphine, and naltrexone--as many as 3 out of 4 people with OUD are not on any of these lifesaving medications, which speaks to failures in implementation. The penetration of fentanyl into the opioid supply has made strategies for initiation of buprenorphine even more complex. Growing literature describes increased precipitated withdrawal at the time of buprenorphine initiation, thought to be secondary to the lipophilic nature of fentanyl. There is an urgent need to better understand how we can successfully engage more people in treatment that we know decreases morbidity and mortality related to OUD. The work proposed in this K23 application will investigate the initiation of buprenorphine in the setting of fentanyl use from both the patient and provider perspectives. We will utilize novel methods to develop a buprenorphine initiation toolkit and then will pilot the implementation of this new tool. The specific aims of the research are to: 1. Use qualitative methods to explore the experience of both patients and providers initiating buprenorphine for OUD in the setting of fentanyl use. 2a. Conduct a modified Delphi process to investigate expert consensus regarding buprenorphine initiation in the setting of fentanyl. 2b. Work with a multidisciplinary group to develop a buprenorphine initiation toolkit, and 3: Conduct a pilot study to evaluate the acceptability, feasibility and effectiveness of the buprenorphine initiation toolkit. Along with the multipronged training plan, this research will support my overarching goal of becoming an independent physician researcher focused on improving outcomes for people with substance use disorders through innovative implementation approaches.

项目概要与阿片类药物使用相关的发病率和死亡率持续上升，其中芬太尼目前是最严重的尽管 FDA 批准了三种阿片类药物，但常见的阿片类药物导致过量死亡。使用障碍 (MOUD)——美沙酮、丁丙诺啡和纳曲酮——多达四分之三患有 OUD 的人没有服用任何这些救生药物，这说明治疗失败芬太尼渗透到阿片类药物供应中已经制定了战略。越来越多的文献描述丁丙诺啡的引发更加复杂。在开始使用丁丙诺啡时突然戒断，被认为是继发于我们迫切需要更好地了解芬太尼的亲脂性。成功地让更多的人接受治疗，我们知道可以降低发病率和死亡率本 K23 申请中提出的工作将调查 OUD 的启动。从患者和提供者的角度来看，丁丙诺啡在芬太尼使用中的作用。将利用新方法开发丁丙诺啡起始工具包，然后进行试点实施这一新工具的具体目标是： 1. 使用定性方法。探索患者和提供者使用丁丙诺啡治疗的经验的方法芬太尼使用情况下的 OUD 2a。关于芬太尼背景下丁丙诺啡起始的共识 2b。多学科小组开发丁丙诺啡起始工具包，以及 3：进行试点研究评估丁丙诺啡起始工具包的可接受性、可行性和有效性。除了多管齐下的培训计划之外，这项研究将支持我的总体目标：成为一名独立的医师研究员，专注于改善患者的治疗结果通过创新的实施方法解决物质使用障碍。