Risks for Opioid Use and Abuse in Contrasting Chronic Pain Populations

描述（由申请人提供）：我们假设，在患有精神健康障碍的弱势患者中，处方阿片类药物用于慢性疼痛的增加是阿片类药物滥用问题升级和阿片类药物使用的其他负面健康后果的主要原因。本研究将分析2002-2007年来自两个互补来源的索赔数据：1]Highmark-Blue Shield私人保险计划（N= 350万），2]Arkansas Medicaid （N=66万）。我们将研究那些患有三种最常见的慢性非癌性疼痛的人：背痛、关节痛和头痛。2002年，超过70万来自Highmark的患者和超过10万来自Medicaid的患者因为这些疼痛而就诊。2002年，Highmark慢性疼痛组的4.9% （n=34,819）和Medicaid慢性疼痛组的12% （n=12,263）使用慢性阿片类药物（bbb60天/年），为我们提供了超过250,000人年的慢性阿片类药物慢性疼痛患者的观察。这些数据集描述了两个具有地理和人口差异的群体，这些差异可能与阿片类药物使用的不同模式和阿片类药物滥用的不同风险有关。1)患病率/趋势：确定2002-2006年期间背痛、关节炎/关节痛和头痛患者慢性处方阿片类药物使用的患病率（60天/年），并测试随时间的趋势。2)起始：确定这些慢性疼痛疾病的新治疗发作者，并随时间随访，使用Cox比例风险模型评估慢性阿片类药物起始的预测因素。3)停药：在所有慢性阿片类药物使用者中，使用Cox比例风险模型研究阿片类药物停药的预测因素。4)阿片类药物滥用/误用：在曾经是慢性阿片类药物使用者的人群中，使用logistic和泊松回归模型调查预测因素：(a)诊断为阿片类药物滥用或依赖的开始，(b)诊断为非阿片类物质滥用或依赖的开始，(c)提示滥用的阿片类行为（多家药店或处方者，每年365天阿片类药物供应），(d)阿片类药物使用的负面健康结果：死亡、住院、急诊就诊、过量、伤害。5)药物滥用：在2002- 2006年期间患有背痛、关节炎/关节痛和头痛的所有患者中，使用logistic和泊松回归模型调查慢性阿片类药物使用对发展的影响：(a)诊断为阿片类药物滥用或依赖的发病，(b)诊断为非阿片类药物滥用或依赖的发病。从2002-2006年数据得出的模型将用于制定有关阿片类药物使用的风险分层程序，该程序将在研究的最后一年（2007年）进行验证。

DESCRIPTION (provided by applicant): We hypothesize that increasing use of prescribed opioids for chronic pain in vulnerable patients with mental health disorders is the primary reason for escalating problems with opioid abuse and other negative health consequences of opioid use. This study will analyze 2002-2007 claims data from two complementary sources: 1] Highmark-Blue Shield private insurance plan (N= 3.5 million), 2] Arkansas Medicaid (N=660,000) We will study those individuals with the three most common chronic non-cancer pain conditions: back pain, joint pain, and headaches. In 2002, over 700,000 individuals from Highmark and over 100,000 individuals from Medicaid had a visit for one of these pain conditions. In 2002, 4.9% (n=34,819) of this Highmark chronic pain group and 12% (n=12,263) of this Medicaid chronic pain group were prescribed chronic opioids (>60 days/year), offering us over 250,000 person-years of observation of patients with chronic pain on chronic opioids . These datasets describe two groups who have geographical and demographic differences that are likely associated with different patterns of opioid use and different risks for opioid abuse. Specific Aims 1) Prevalence/Trends: To determine prevalence rates of chronic prescription opioid use (> 60 days/year) for patients with back pain, arthritis/joint pain, and headaches during 2002-2006 and test for trends over time 2) Initiation: To identify persons with new treatment episodes for these chronic pain conditions, and follow them over time, using Cox proportional hazards models to assess predictors of chronic opioid initiation. 3) Discontinuation: Among all current chronic opioid users, to use Cox proportional hazards models to investigate the predictors of opioid discontinuation . 4) Opioid Abuse/Misuse: Among those who have ever been chronic opioid users, to use logistic and Poisson regression models to investigate predictors of: (a) Onset of diagnosed opioid abuse or dependence, (b) Onset of diagnosed non-opioid substance abuse or dependence, (c) Opioid behaviors suggestive of misuse (multiple pharmacies or prescribers, >365 days opioid supply/yr), (d) Negative health outcomes of opioid use: deaths, hospitalizations, ER visits, overdoses, injuries. 5) Substance Abuse: Among all patients with back pain, arthritis/joint pain, and headaches during 2002- 2006, to use logistic and Poisson regression models to investigate the effect of chronic opioid use on developing: (a) Onset of diagnosed opioid abuse or dependence, (b) Onset of diagnosed non-opioid substance abuse or dependence 6) Risk Stratification: Models derived from 2002-2006 data will be used to formulate risk stratification procedures concerning opioid use which will be validated in the final year (2007) of the study.