The impact of chronic pain on buprenorphine treatment retention among patients with opioid use disorder.

摘要 减少全国阿片类药物相关发病率和死亡率的关键办法包括 最大化阿片类激动剂疗法(OAT)在OUD患者中的保留率。特别是，燕麦片 与美沙酮相比，丁丙诺啡可能是许多尿毒症患者合适的起始点。 考虑到其相对更广泛的安全概况(例如，过量服药的可能性较低)，以及更容易获得和 降低相关耻辱，因为它可以在办公室医疗环境中开具处方。尽管如此，在 确实使用丁丙诺啡的部分，长期治疗保留率，这对促进 最好的结果都很低。因此，更好地了解丁丙诺啡治疗的障碍 需要保留，以便为优化当前有效治疗做法的努力提供信息。一 在许多OUD患者中，可能对丁丙诺啡治疗保留产生负面影响的共同因素是 慢性非癌性疼痛(CNCP)的共生存在。目前的研究表明，多达 大约三分之二的OUD患者在医疗环境中，丁丙诺啡的治疗可以是 适用，有共同发生的CNCP条件。然而，尽管CNCP在患者中普遍存在 对于OUD，人们对其对丁丙诺啡治疗保留的影响知之甚少。现在的R03 该提案将通过对大量电子健康记录进行二次分析来解决文献中的这一差距 接受丁丙诺啡治疗的OUD患者数据库。此应用程序的总体目标是更好地 了解CNCP如何作为降低丁丙诺啡滞留率的风险因素，进而了解如何 丁丙诺啡的治疗可以优化以改善伴发的患者的保留结果 OUD和CNCP。具体来说，我们将首先确定CNCP对治疗的影响程度 保留依赖于治疗期间不受控制的疼痛，其特征是通过多水平增长曲线建模。 为了补充这些发现，我们将进行回顾图表审查，以确定在多大程度上 据报道，持续的疼痛与其他原因导致过早停止治疗。原因也将是 由经验性定义的丁丙诺啡依从性轨迹组识别，以表明时间特异性 停产原因。此外，我们的目标是阐明丁丙诺啡剂量和 同时发生OUD和CNCP患者的治疗保留，这可能代表着一种可修改的 可以有针对性地提高留存率的因素。总而言之，这项研究的发现可能会告诉我们 有针对性地努力加强已经存在的治疗OUD的临床影响，以面对迅速的 阿片类药物流行增加，这最终可能导致阿片类药物相关发病率和 死亡率和昂贵的医疗保健使用率。

Abstract A critical approach to reducing the national epidemic of opioid-related morbidity and mortality includes maximizing retention rates of opioid agonist therapy (OAT) among individuals with OUD. In particular, OAT using buprenorphine, compared to methadone, may be a suitable starting point for many patients with OUD given its relatively broader safety profile (e.g., lower likelihood of overdose), and increased accessibility and lower associated stigma given that it can be prescribed in office-based medical settings. Nevertheless, among the fraction that do utilize buprenorphine, rates of long-term treatment retention, which are crucial to facilitating best outcomes, are low. Thus, a better understanding of the barriers to sufficient buprenorphine treatment retention are needed in order to inform efforts at optimizing current practice of an effective treatment. One factor common among many patients with OUD that may negatively affect buprenorphine treatment retention is the co-occurring presence of chronic non-cancer pain (CNCP). Current research shows that up to approximately two-thirds of patients with OUD in medical settings, for whom buprenorphine treatment could be applicable, have a co-occurring CNCP condition. However, despite the prevalence of CNCP among patients with OUD, remarkably little is known about its impact on buprenorphine treatment retention. The present R03 proposal will address this gap in the literature through secondary analysis of a large electronic health record database of patients receiving buprenorphine treatment for OUD. The overall goal of this application is to better understand how CNCP may operate as a risk factor for lower buprenorphine retention, and in turn, how buprenorphine treatment can be optimized to improve retention outcomes among patients with co-occurring OUD and CNCP. Specifically, we will first determine the extent to which the impact of CNCP on treatment retention depends on uncontrolled pain during treatment characterized via multi-level growth curve modeling. To supplement these findings, we will conduct retrospective chart reviews to identify the extent to which ongoing pain vs. other reasons were reported for premature treatment discontinuation. Reasons will also be identified by empirically-defined buprenorphine adherence trajectory groups to indicate temporal specificity of discontinuation reasons. Furthermore, we aim to elucidate the association between buprenorphine dose and treatment retention among patients with co-occurring OUD and CNCP, which may represent a modifiable factor that could be targeted to improve retention. Together, the findings from this research may inform targeted efforts to enhance the clinical impact of an already existing treatment for OUD in the face of a rapidly increasing opioid epidemic, which could ultimately lead to greater reductions in opioid-related morbidity and mortality and costly healthcare utilization.