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.

在美国阿片类药物相关发病率和死亡率不断增加的情况下，安全、有效和 慢性疼痛的综合管理至关重要。患有慢性疼痛的人 OUD 以及种族和族裔少数群体值得特别关注，因为他们可能受到不充分对待 疼痛和 OUD，以及不良健康结果的风险增加。 2016年，疾病预防控制中心 和预防 (CDC) 发布了一项重要的临床实践指南，强调非阿片类药物和 疼痛管理的非药物替代品，并建议如果阿片类药物是更安全的处方做法 用于治疗慢性疼痛。对慢性疼痛治疗模式随时间变化的检查 少数民族和同时患有 OUD 的弱势群体需要了解和 解决慢性疼痛指南一致治疗中的健康差异。利用2015年 2018 年医疗保险登记数据与住院患者、门诊患者和处方药索赔数据相结合 20%全国样本，拟议的研究目的是：（1）评估种族和民族类型的差异 向患有 OUD 共病的人提供的慢性疼痛治疗，以及 (2) 评估是否 CDC 指南的实施影响了慢性疼痛治疗中的种族/民族差异 对于那些有 OUD 的人。我们将疼痛治疗分为药物性、非药物性和非药物性。 药理学与非药理学的结合。在处方阿片类药物中，我们将评估 与阿片类药物剂量和同时服用苯二氮卓类药物相关的处方指南一致性 处方。我们假设具有 OUD 的少数种族/族裔不太可能接受指导 与 OUD 白人慢性疼痛患者相比，阿片类药物管理和非药物治疗一致。我们 进一步预计疾病预防控制中心阿片类药物发布后慢性疼痛治疗的差异将进一步恶化 指导方针。如果得到证实，我们将探讨差异的潜在来源（例如，共同处方纳洛酮、 疼痛和成瘾专家的参与）可以为改善慢性疼痛的干预措施提供信息 对同时发生 OUD 的患者进行治疗。这项研究的长期目标是表征和 减少人们在接受建议的护理标准和循证治疗方面的差异 伴有同时发生的慢性疼痛和 OUD。我们的研究结果将为更多的研究提供急需的证据 有效和公平的公共卫生和健康保险政策，并可以为未来的临床指南提供信息。