Quantification and Characterization of Opioid Prescription, Overdose, and Fatalities in People with Cancer: A Massive Nationwide, Multi-Cohort Study

从20世纪90年代末开始的处方阿片流行，S在全国范围内大规模扩张阿片类药物处方，最终导致专业协会、医疗保健系统和立法机构采取措施遏制阿片类药物的不当处方，特别是大剂量和长期使用。虽然其中一些措施产生了戏剧性和持续的总体影响，但人们对阿片类药物处方的趋势以及与阿片类药物相关的不良事件和死亡率对癌症幸存者人群的影响知之甚少。中度至重度癌症疼痛需要阿片类药物治疗是非常常见的，随着癌症幸存者人口的持续增长，也有必要了解阿片类药物相关政策(即使是那些专门排除癌症患者的政策)如何影响获得适当的疼痛管理。该项目在两个不同的人群(美国退伍军人和联邦医疗保险受益人)中使用匹配的纵向队列方法，以便纵向和定量地描述癌症患者在以下方面的变化：阿片处方率和剂量、阿片类药物治疗持续时间、阿片类药物的选择、与阿片类药物相关的住院和急诊科就诊、阿片类药物滥用或依赖的新诊断、以及阿片类药物相关不良事件的急诊室就诊或住院、药物辅助治疗(MAT)计划的登记情况以及阿片类药物过量事件的病死率。通过研究2008-2018年间的这些事件，我们将能够在医疗系统、州和联邦层面评估几波与阿片类药物相关的指导方针、政策和法律的影响，以了解美国对处方阿片类药物流行的反应对癌症患者的影响。最后，这项研究的第二个目标将是使用嵌套病例对照研究来具体分析癌症患者和非癌症患者中的阿片类药物过量事件，以确定致命过量的风险因素，包括获得处方阿片类药物的情况。归根结底，这个项目有可能弥合对癌症患者中处方阿片类药物流行的几个关键差距，这可以在短期内帮助患者和临床医生更好地评估阿片类药物治疗的风险和好处，并在长期内使政策制定者和专业社会能够更准确地了解与阿片类药物相关的政策对癌症患者的溢出影响。

The prescription opioid epidemic, beginning in the late 1990’s saw massive expansion of opioid prescriptions nationwide, ultimately leading professional societies, healthcare systems, and legislative bodies to take measures curbing inappropriate prescription of opioids, particularly at high doses and for chronic use. While some of these have had dramatic and sustained overall effects, there is little known about how trends in opioid prescription, nor opioid-related adverse events and mortality have changed for the cancer survivor population. Moderate to severe cancer pain warranting opioid therapy is very common, and as the cancer survivor population continues to grow, so too does the need to understand how opioid-related policies (even those specifically excluding people with cancer) has affected access to appropriate pain management. This project uses a matched longitudinal cohort methodology in two distinct populations (US veterans and Medicare beneficiaries) in order to longitudinally and quantitatively characterize in people with cancer changes in: opioid prescription rate and dosage, duration of opioid therapy, choices of opioids, opioid-related hospitalizations and emergency department visits, new diagnosis of opioid abuse or dependence, as well as ER visits or hospital admissions for opioid-related adverse events, enrollment in Medication-Assisted Treatment (MAT) programs, and the case fatality rate of opioid overdose events. By studying these events between 2008-2018, we will be able to evaluate the effects of several waves of opioid-related guidelines, policies, and laws at the healthcare system, state, and federal level to see how cancer patients have been affected by the US response to the prescription opioid epidemic. Finally, a second aim of the study will be to use a nested case-control study to specifically analyze opioid overdose events in people with cancer versus those who do not, in order to characterize risk factors for fatal overdoses, including access to prescription opioids. Ultimately, this project has the potential to close several key gaps in the understanding of the prescription opioid epidemic in people with cancer, which could in the immediate term help patients and clinician to better evaluate the risks and benefits of opioid therapy, and in the longer term allow policymakers and professional societies to have a more precise understanding of spillover effects of opioid-related policies on people with cancer.