Role of disability and pain in opioid overdose: mechanism and risk mitigation

残疾和疼痛在阿片类药物过量中的作用：机制和风险缓解

基本信息

批准号：
10362026
负责人：
Kara Elizabeth Rudolph
金额：
$ 73.81万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-03-01 至 2027-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10362026
关键词：
Adult Affect Affordable Care Act Aftercare Benzodiazepines Cessation of life Chronic Confounding Factors (Epidemiology)County Disabled Persons Disease Management Economics Exclusion Exposure to Future Gender Geography Goals High Prevalence Hospitalization Injury Insurance Intervention Joints Left Link Literature Low income Machine Learning Mediating Mediation Mediator of activation protein Medicaid Mental Depression Methods Musculoskeletal National Institute of Drug Abuse Opioid Opioid Analgesics Outcome Overdose Overdose reduction Pain Pain management Pathway interactions Persons Pharmaceutical Preparations Population Practice Management Prevalence Prevention Prevention strategy Property Qualifying Research Risk Role Statistical Methods Stimulant Subgroup Substance Use Disorder Vulnerable Populations beneficiary chronic pain chronic pain management chronic painful condition comorbidity disability experience geographic difference high risk improved indexing middle age multimodality non-cancer pain novel opioid epidemic opioid misuse opioid overdose opioid use disorder overdose death overdose risk physically handicapped prescription opioid racial and ethnic risk mitigation stressor substance use substance use treatment surveillance study

项目摘要

Drug overdose deaths in the US have increased exponentially, driven by opioid overdoses. Concurrently, US surveillance studies have documented increased disability prevalence among adults in midlife. People with disabilities have higher rates of opioid use disorder (OUD) but are less likely to receive treatment for it, putting them at higher risk for opioid overdose. Despite these established risks, people with disabilities remain an understudied subpopulation in the context of the opioid crisis. Much of heightened risk among the disabled population may be due to chronic pain. Many people with physical disability experience chronic pain that either drives the disability, termed “high-impact chronic pain”, or that occurs concurrently. Chronic pain is frequently managed with prescription opioids, sometimes via risky prescribing practices. In addition to chronic pain, pathways through depression or through loss of economic opportunity and its accompanying stressors may link physical disability to overdose risk. Opioid prescribing for chronic pain has been linked to increased risk of opioid overdose, but any such risk conferred by having a physical disability, disentangled from chronic pain, has not been estimated—nor has the risk associated with co-occurring physical disability and chronic pain. Moreover, the mechanisms through which disability and chronic pain operate to affect overdose risk are unknown. Availability of recommended treatments for substance use disorders (SUDs), including OUD, and chronic pain may influence the relationships, mechanisms, and the associated disparities we propose to study, but is highly variable across localities. The objectives of this project are: Aim 1) to estimate the unique and joint contributions of physical disability and chronic pain conditions to opioid overdose risk and the extent to which pain management practices mediate these relationships; Aim 2) to develop novel statistical methods to transport mediated effects from one state to another, and to apply those methods in Aim 3) to identify SUD and pain management treatment metrics that, if improved, may reduce both overall overdose risk associated with physical disability and chronic pain and disparities in overdose risk by racial/ethnic-gender subgroup. We will harness geographic variation in the delivery of SUD and pain management treatment and predict the effects that realistic improvements in delivery would have on reducing opioid overdose in this vulnerable population. The proposed research is expected to estimate the extent to which physical disability increases risk of opioid overdose, the proportion of that increased risk attributable to chronic pain and attendant risky pain manage- ment practices (versus non-chronic pain mechanisms), and the extent to which risk may be mitigated by improvements in delivering appropriate chronic pain management and SUD (including OUD) treatment. This will allow for future prevention strategies to be tailored to the particular needs and challenges faced by people with physical disabilities, with the goal of ultimately making a significant contribution to improving prescribing practices and provision of recommended treatments to reduce their risk of opioid overdose.

同时，由于阿片类药物过量，美国因药物过量死亡呈指数增长。美国监测研究表明，中年成年人的残疾患病率有所增加。残疾人阿片类药物使用障碍 (OUD) 的发生率较高，但接受治疗的可能性较小尽管存在这些既定风险，但残疾人仍面临更高的阿片类药物过量风险。在阿片类药物危机的背景下，该人群仍然是一个未被充分研究的亚人群。残疾人群可能会遭受慢性疼痛许多身体残疾的人都会经历慢性疼痛。要么导致残疾，称为“高影响慢性疼痛”，要么同时发生慢性疼痛。除了慢性治疗外，还经常使用处方阿片类药物进行治疗，有时还通过危险的处方做法进行治疗。痛苦、抑郁症或经济机会丧失及其伴随的压力源的途径身体残疾可能与服用过量阿片类药物治疗慢性疼痛的风险增加有关。阿片类药物过量的风险，但任何此类风险都是由身体残疾造成的，与慢性病无关疼痛，尚未估计，也没有估计与同时发生的身体残疾和慢性病相关的风险此外，残疾和慢性疼痛影响用药过量风险的机制是不同的。药物滥用障碍 (SUD) 的推荐治疗方法（包括 OUD）的可用性未知。慢性疼痛可能会影响我们建议研究的关系、机制和相关差异，但各地情况差异很大。该项目的目标是：目标 1) 估计独特的和身体残疾和慢性疼痛对阿片类药物过量风险的共同影响及其程度哪些疼痛管理实践可以调节这些关系目标 2) 开发新的统计方法从一种状态到另一种状态的传输介导效应，并应用目标 3) 中的这些方法来识别 SUD 和疼痛管理治疗指标如果得到改善，可能会降低与以下相关的总体用药过量风险身体残疾和慢性疼痛以及不同种族/族裔性别亚组的用药过量风险差异。利用 SUD 和疼痛管理治疗的地理差异并预测效果交付方面的实际改进将有助于减少这一弱势群体中阿片类药物的过量使用。拟议的研究预计将估计身体残疾增加阿片类药物风险的程度过量服用，因慢性疼痛和随之而来的危险疼痛管理而增加的风险比例治疗实践（相对于非慢性疼痛机制），以及通过以下方式可以减轻风险的程度：改善提供适当的慢性疼痛管理和 SUD（包括 OUD）治疗。将允许未来的预防战略根据人们面临的特殊需求和挑战进行定制患有身体残疾，目标是最终为改善处方做出重大贡献实践并提供推荐的治疗方法，以降低阿片类药物过量的风险。