Real-world complexities in opioid use disorder treatment: understanding family comorbidity, high-risk medication use, and costs related to treatment adherence and health outcomes

项目总结 治疗阿片使用障碍(MOUD)的药物有可能改善更多人的健康和福祉 然而，超过210万患有OUD的美国人，特别是丁丙诺啡的长期坚持令人震惊 可怜。疼痛、心理健康和物质使用障碍日益被认为是不足的危险因素。 由于共同的遗传和环境因素，坚持治疗并经常在家庭中共同发生。 了解OUD患者及其家庭成员的合并症及其影响 不良阿片类药物使用结果的共病，可以帮助识别治疗依从性不足的风险患者 以及严重的不良事件。此外，关于丁丙诺啡不遵守的相关费用的信息 家庭合并症可以影响医疗保险的报销政策。职业生涯的总体目标是 接受者将成为领先的药物流行病学家，专注于改善药物使用的治疗 障碍，特别是阿片类药物使用障碍。此K01的目标是训练收件人调查关联 家庭合并症和/或滥用风险高的处方药和丁丙诺啡之间的关系 治疗依从性、阿片类药物使用结果以及家庭单位和健康保险公司的成本。研究目标： 本项目的目的是：(1)开发一个临床相关的预测模型，以确定患者开出的丁丙诺啡处方 面临坚持不充分的风险；(2)确定家庭中的其他处方是否与贫困有关 丁丙诺啡依从性和阿片类药物相关不良事件；以及(3)比较总体医疗成本与 家庭和健康保险公司遵守丁丙诺啡的程度各不相同。该项目的培训目标是 目的：(1)了解阿片类药物使用障碍和精神障碍的临床评估和诊断 健康状况；(2)学习和应用二元数据分析的创新方法；(3)学习和应用方法 进行药物使用治疗的经济评价；(4)磨练研究专业技能， 出版和项目管理；以及(5)负责任的研究行为。将追求培训目标 通过与世界知名专家的教程组成受助者的研究生级别的指导团队 课程作业、工作坊和研讨会、参加科学会议和指导研究。研究 目标将通过使用大型综合商业医疗保健的OpumLabs数据仓库来实现 保险索赔数据库，跟踪不同健康计划的受益人、配偶和受抚养人 时间到了。这个项目将填补我们对家庭合并症和药物使用的理解上的一个重要空白 家庭成员影响Moud治疗的依从性、结果和成本，并将提供证据 支持临床医生和健康保险公司的干预措施，以改善Moud依从性结果。

PROJECT SUMMARY Medications for opioid use disorder (MOUD) have the potential to improve the health and well-being of more than 2.1 million Americans with OUD, however, long-term adherence particularly to buprenorphine is alarmingly poor. Pain, mental health, and substance use disorders are increasingly recognized as risk factors for inadequate treatment adherence and often co-occur in families due to shared genetic and environmental factors. Understanding comorbidities in patients with OUD and their family members, and the impact of these comorbidities on poor opioid use outcomes, can help identify patients at risk for inadequate treatment adherence and serious adverse events. Further, information on the costs associated with buprenorphine non-adherence and family comorbidities can inform health insurance reimbursement policies. The overall career goal of the recipient is to become a leading pharmacoepidemiologist focused on improving treatment for substance use disorders, particularly opioid use disorders. The goal of this K01 is to train the recipient to investigate associations between family comorbidities and/or prescription medications with a high risk of misuse and buprenorphine treatment adherence, opioid use outcomes, and costs to the family unit and health insurer. Research aims of this project are to: (1) develop a clinically relevant prediction model to identify patients prescribed buprenorphine at risk of inadequate adherence; (2) determine whether other prescriptions in the family are associated with poor buprenorphine adherence and opioid-related adverse events; and (3) compare overall healthcare costs to the family and health insurer across varying levels of buprenorphine adherence. The training aims of this project are to: (1) gain understanding of the clinical assessment and diagnosis of opioid use disorders and comorbid mental health conditions; (2) learn and apply innovative methods for dyadic data analyses; (3) learn and apply methods for conducting economic evaluations of substance use treatment; (4) hone professional skills in research, publishing, and project administration; and (5) responsible conduct of research. Training aims will be pursued through tutorials with world-renowned experts forming the recipient's mentorship team, graduate-level coursework, workshops and seminars, participation in scientific meetings, and mentored research. Research aims will be accomplished using the OptumLabs Data Warehouse, a large integrated commercial healthcare insurance claims database that tracks beneficiaries, spouses, and dependents across health plans and over time. This project will fill an important gap in our understanding of how family comorbidities and medication use by family members influence MOUD treatment adherence, outcomes, and costs, and will provide evidence to support interventions by clinicians and health insurers to improve MOUD adherence outcomes.