Pain, Multimorbidity, Opioid-Drug Interactions and Risk for Opioid Use Disorder or Overdose in Older Adults

老年人的疼痛、多重发病、阿片类药物相互作用以及阿片类药物使用障碍或过量的风险

• 批准号: 10659436
• 负责人: Yu-Jung Wei
• 金额: $ 40万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-10 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10659436
• 关键词: Pain; Multimorbidity; Opioid; Drug; Interactions

This study proposes longitudinal research among older adults to assess the associations of uncontrolled pain, co-occurring chronic conditions or geriatric symptoms (multimorbidity), and opioid–drug interactions with risk for opioid use disorder (OUD) or overdose (OD). This study is responsive to AHRQ’s special interest (NOT-HS- 21-010) in research to address substance use disorders, including OUD and OD in older adults. Older adults have experienced significant increases in OUD or OD in the last decade despite a decrease in the number of opioid prescriptions, signaling an urgent need to identify factors beyond prescription opioid use that contribute to OUD/OD to inform interventions in older populations. Pain, multimorbidity, and polypharmacy, all strongly associated with advancing age, are frequently noted as potential risk factors for OUD/OD in older adults, but relevant evidence is lacking. Relieving pain is the most frequent motive for opioid misuse in older adults, but to what extent uncontrolled pain contributes to risk for OUD/OD is unknown. Multimorbidity is highly prevalent in older adults with OUD or OD, but its association with uncontrolled pain and the joint association of multimorbidity and uncontrolled pain with risk for OUD/OD are unknown. There is also limited understanding regarding the risk of OUD/OD when prescription opioids for pain treatment are concurrently used with drugs for other chronic comorbid conditions that may interact with opioids in older adults. To fill these research gaps, this proposed study will leverage a 100% Medicare sample and Medicare data linked to nationally representative longitudinal survey data to study the associations of pain, multimorbidity, and opioid-drug interactions with risk for OUD/OD outcomes of older adults with chronic pain. Specifically, we will examine the associations between pain control and risk for OUD or OD in older adults diagnosed with chronic pain and treated with prescription opioids. We will also evaluate the association of multimorbidity with pain control and their joint association with OUD/OD risk in older patients. Furthermore, we will assess the extent to which concurrent use of opioids with drugs for treating common comorbid conditions with chronic pain in older adults is associated with OUD/OD outcomes in older adults with chronic pain. We will measure both pain and high-impact pain and quantify multimorbidity through both a diagnosis-based index and the presence of geriatric symptoms that are underdiagnosed or not diagnosable. Our study will provide empirical evidence on the extent to which uncontrolled pain, multimorbidity, and opioid-drug interactions may play a role in increasing risk for OUD or OD among older adults with chronic pain. Given the accelerated growth of the US aging population and the continuing increase in OUD, OD, and opioid misuse, our data will inform interventions that integrate care for chronic pain and other chronic comorbid conditions to improve pain control while reducing OUD or OD in older adults.

这项研究建议对老年人进行纵向研究，以评估不受控制的疼痛、 同时发生的慢性病或老年症状（多发病）以及阿片类药物与风险的相互作用 针对阿片类药物使用障碍 (OUD) 或过量 (OD) 这项研究响应了 AHRQ 的特殊兴趣 (NOT-HS-)。 21-010）致力于解决药物滥用障碍的研究，包括老年人的 OUD 和 OD。 尽管在过去十年中 OUD 或 OD 的数量有所减少，但 OUD 或 OD 仍显着增加 阿片类药物处方，表明迫切需要确定处方阿片类药物使用之外的其他因素 OUD/OD 为老年人群的干预措施提供信息，这些都非常重要。 与年龄增长相关，经常被认为是老年人 OUD/OD 的潜在危险因素，但是 缺乏相关证据。缓解疼痛是老年人滥用阿片类药物的最常见动机。 无法控制的疼痛对 OUD/OD 风险的影响程度尚不清楚。 患有 OUD 或 OD 的老年人，但其与不受控制的疼痛以及关节相关 多发病和不受控制的疼痛与 OUD/OD 的风险尚不清楚。 关于用于疼痛治疗的处方阿片类药物与用于治疗疼痛的药物同时使用时 OUD/OD 的风险 可能与老年人中阿片类药物相互作用的其他慢性合并症。 拟议的研究将利用 100% 医疗保险样本和与全国代表性相关的医疗保险数据 研究疼痛、多发病以及阿片类药物相互作用与风险之间关系的纵向调查数据 具体来说，我们将研究患有慢性疼痛的老年人的 OUD/OD 结果。 诊断患有慢性疼痛并接受以下治疗的老年人的疼痛控制与 OUD 或 OD 风险之间的关系 我们还将评估多种疾病与疼痛控制及其关节的关系。 此外，我们将评估同时使用的程度。 阿片类药物与治疗老年人慢性疼痛常见合并症的药物的使用量相关 我们将测量患有慢性疼痛的老年人的 OUD/OD 结果。 通过基于诊断的指数和老年症状的存在来多重量化发病率 我们的研究将为诊断不足或无法诊断的程度提供经验证据。 不受控制的疼痛、多发病和阿片类药物相互作用可能会增加 OUD 或 OD 的风险 鉴于美国人口老龄化的加速增长和慢性疼痛的老年人。 OUD、OD 和阿片类药物滥用的持续增加，我们的数据将为护理干预措施提供信息 慢性疼痛和其他慢性合并症，以改善疼痛控制，同时减少老年人的 OUD 或 OD 成年人。