Multi-level associations between opioid use and overdose: Individual, clinical, and population-based risk factors for fatality

阿片类药物使用与过量之间的多层次关联：个体、临床和人群的死亡危险因素

• 批准号: 10416000
• 负责人: Hillary Samples
• 金额: $ 19.61万
• 依托单位: RUTGERS BIOMEDICAL/HEALTH SCIENCES-RBHS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10416000
• 关键词: Accidental Injury; Accounting; Address; Admission activity; Adult; Age; American; Area; Cause of Death; Cessation of life; Characteristics; Clinical; County; Data; Data Files; Data Sources; Death Rate; Development; Development Plans; Disabled Persons; Disadvantaged; Dose; Early Intervention; Education; Eligibility Determination; Enrollment; Ethics; Ethnic Origin; Formulation; Funding; Geography; Goals; Guidelines; Health; Health Resources; Health Services Accessibility; Health Services Research; Health Status; Health system; Healthcare; Healthcare Systems; Hospitals; Improve Access; Income; Individual; Intervention; Knowledge; Life Expectancy; Link; Longitudinal Studies; Measures; Medicaid; Medical; Mental disorders; Mentorship; Methodology; Methods; Minority; Monitor; Morbidity - disease rate; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Overdose reduction; Pain; Pain management; Pathway interactions; Pattern; Patterns of Care; Pharmaceutical Preparations; Pharmacy facility; Policies; Policy Research; Population; Population Characteristics; Poverty; Practice Guidelines; Prescription opioid overdose; Public Health; Race; Reporting; Research; Research Methodology; Research Personnel; Research Training; Resources; Risk; Risk Factors; Secure; Services; Socioeconomic Factors; Strategic Planning; System; Time; Training; Training Support; Unemployment; Universities; Vulnerable Populations; Work; abuse liability; base; beneficiary; career; career development; chronic pain; clinical care; clinical epidemiology; clinical pain; comorbidity; contextual factors; disability; dosage; effective intervention; geographic difference; health care availability; high risk population; improved; indexing; innovation; mortality; non-cancer chronic pain; novel; opioid epidemic; opioid mortality; opioid overdose; opioid use; opioid use disorder; overdose death; overdose risk; patient population; personalized approach; population based; population health; prescription monitoring program; prescription opioid; prevent; programs; response; rural counties; sex; social; social epidemiology; social structure; sociodemographic factors; sociodemographics; spatial epidemiology; statistics; stem; substance use; tertiary prevention; theories; trend

PROJECT SUMMARY: Over the past two decades, high rates of opioid prescribing have led to widespread opioid use and epidemic levels of adverse opioid-related outcomes. Early interventions focused on reducing opioid prescribing through the development of practice guidelines and implementation of programs and policies to increase prescription opioid management and monitoring. While overall opioid prescribing has declined in recent years and may have contributed to reductions in prescription opioid-involved overdose death rates in 2012 and 2013, the rate has since risen to a new high, comprising 40% of all opioid-related deaths in 2016. Furthermore, prescribing remains elevated in disadvantaged groups and areas, highlighting a need to better understand how individual characteristics intersect with health system and population-level factors in the pathways from opioid use to fatal and non-fatal overdose. Using a multi-level approach, the proposed project examines trajectories from opioid treatment for chronic non-cancer pain to opioid overdose and fatality, accounting for: 1) individual sociodemographic and clinical characteristics (e.g. sex, age, race/ethnicity, comorbidities), 2) opioid treatment patterns (e.g. dosage, duration, formulation), 3) county-level health system (e.g. facilities, services) and population characteristics (e.g. percent poverty, minority, unemployed, disabled), and 4) state-level policies (e.g. Medicaid policies, Prescription Drug Monitoring Programs). Opioid treatment patterns will be assessed using national Medicaid Analytic Extract (MAX) data, adjusting for individual characteristics. Risk of overdose based on individual characteristics and treatment patterns will be assessed using MAX data for medically treated non-fatal opioid overdose and National Death Index (NDI) data for fatal opioid overdose. Overdose outcomes will be further assessed using county-level Area Health Resource File (AHRF) data and state-level policy measures. Contextualizing individual outcomes within wider health care systems and social and geographic settings supports NIDA’s strategic plan to increase the public health impact of research. Additional substantive and methodological training will contribute to the applicant’s long-term goal to develop an independent academic research career and generate and disseminate robust evidence to inform effective interventions to reduce opioid-related morbidity and mortality. The training aims include advanced study and application of: 1) innovative methods to characterize clinical care patterns over time, 2) social and spatial epidemiology theory and methods to study multilevel influences on health, 3) policy drivers of health and health care, and 4) professional development for conducting ethical, independent research. The research and training are supported by an interdisciplinary mentorship team of Columbia University researchers with expertise in substance use and policy research, clinical and spatial epidemiology, and statistics with additional support from external collaborators in health services and policy research methods. This project and career development plan will prepare the applicant to secure R01 funding to extend this line of research.

项目总结：在过去的二十年里，阿片类药物的高处方率导致了广泛的