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Mentoring Junior Investigators to Tackle the Opioid Epidemic

指导初级研究人员应对阿片类药物流行病

基本信息

批准号：
9888338
负责人：
Joanna L. Starrels
金额：
$ 18.87万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-03-01 至 2024-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9888338
关键词：
AIDS prevention Acupuncture Therapy Address Adherence Adopted Adoption Applications Grants Award Buprenorphine Caring Centers for Disease Control and Prevention (U.S.)Chronic Clinical Cohort Studies Data Data Collection Data Set Development Dose Dropout Effectiveness Effectiveness of Interventions Epidemic Fracture Funding Future Goals Guidelines HIV Health Policy Incidence Individual Intervention Interview Lead Learning Manuscripts Medical Marijuana Mentors Mentorship Methodology Mid-Career Clinical Scientist Award (K24)Nonpharmacologic Therapy Observational Study Opioid Outcome Pain Patient Preferences Patient-Focused Outcomes Patients Pharmaceutical Preparations Physicians Primary Health Care Provider Public Health Quality of life Research Research Infrastructure Research Methodology Research Personnel Resources Risk Testing Training Support Translating Viral Load result Withdrawal Symptom antiretroviral therapy career career development chronic pain chronic pain management chronic pain patient clinical practice cohort comparative effectiveness depressive symptoms evidence base experimental study falls high risk illicit opioid implementation science injection drug use innovation mindfulness meditation opioid epidemic opioid injection opioid tapering opioid use opioid use disorder overdose death overdose risk patient oriented research patient subsets prescription opioid primary care setting programs prospective public health emergency recruit research and development response responsible research conduct risk mitigation sex skills stem tool transmission process

项目摘要

ABSTRACT My overall goal is to advance the evidence needed to stem the opioid epidemic, and to translate the evidence into real-world implementation and effective public health policy. The current opioid epidemic in the US was driven by widespread use of prescription opioids (POs) for chronic pain. In response, guidelines and health policies increasingly promote use of opioid risk mitigation strategies such as PO tapering (reducing the dose or discontinuing POs). However, adoption of opioid risk mitigation strategies is outpacing the evidence, for example, outcomes of PO tapering and optimal strategies for implementing PO tapering in real-world HIV and primary care settings are unknown. PO tapering can have particularly serious implications for HIV control, if tapering causes patients to fall out of HIV care or replace POs with illicit or injected opioid use; but the risks have not been quantified and factors associated with these outcomes have not been described. Given the overall lack of evidence about PO risk mitigation strategies and their implementation and the urgency of addressing the epidemic, it is imperative to expand the capacity of clinician-investigators conducting patient- oriented research on PO use in HIV+ and HIV- individuals. I am a physician who treats chronic pain and opioid use disorder, an investigator focused on judicious PO prescribing for over a decade, and an educator with a strong mentoring track record and exceptional institutional resources to support mentees. This K24 mid-career investigator award will help to expand capacity of clinician investigators in the field by: 1) providing outstanding mentorship to junior investigators focused on PO use in chronic pain, 2) expanding my research in implementation science methodologies to optimize translating evidence into practice, and 3) advancing my development as a leader in translating evidence about PO use into guidelines and health policy. My strong existing research program focused on PO risk mitigation practices for HIV+ and HIV- patients with chronic pain, along with exceptional advisors and institutional resources, will provide a platform for mentoring and expanding my skills. Using my existing study cohorts and new primary data collection including qualitative interviews and a discrete choice experiment, we propose the following new research aims: 1) to examine the positive and negative outcomes of PO tapering among HIV+ and HIV- patients with chronic pain, and 2) to identify patient preferences for different PO tapering strategies among HIV+ and HIV- patients with chronic pain and high-risk PO use. All proposed research will be conducted with mentees and will provide ample opportunities for mentee development in diverse research methods, responsible conduct of research, and preparing manuscripts and grant applications. Findings from the research will inform future interventions and guidelines for PO tapering. Overall, the proposed plans for mentoring, career development, and research will expand capacity to address the opioid epidemic.

抽象的我的总体目标是提供遏制阿片类药物流行所需的证据，并转化这些证据融入现实世界的实施和有效的公共卫生政策。目前美国的阿片类药物流行病是广泛使用处方阿片类药物 (PO) 来治疗慢性疼痛。作为回应，指南和健康政策越来越多地促进使用阿片类药物风险缓解策略，例如 PO 逐渐减少（减少剂量或停止 PO）。然而，阿片类药物风险缓解策略的采用速度超过了证据，因为例如，PO 逐渐减少的结果以及在现实世界的 HIV 和中实施 PO 逐渐减少的最佳策略初级保健机构未知。 PO 逐渐减少可能对 HIV 控制产生特别严重的影响，如果逐渐减少导致患者不再接受艾滋病毒护理或用非法或注射阿片类药物替代 PO；但风险尚未量化，也未描述与这些结果相关的因素。鉴于总体上缺乏关于 PO 风险缓解策略及其实施的证据以及采取紧急措施的紧迫性应对这一流行病，当务之急是提高临床医生和研究人员开展患者研究的能力。针对 HIV+ 和 HIV- 个体使用 PO 的研究。我是一名治疗慢性疼痛和阿片类药物的医生使用障碍，十多年来专注于明智的 PO 处方的调查员，以及具有强大的指导记录和卓越的机构资源来支持受训者。这个K24职业生涯中期研究者奖将通过以下方式帮助扩大临床研究者在该领域的能力：1）提供杰出的对初级研究人员的指导，重点是 PO 在慢性疼痛中的使用，2）扩大我的研究范围实施科学方法来优化将证据转化为实践，以及3）推进我的发展成为将 PO 使用证据转化为指南和卫生政策的领导者。我的坚强现有的研究计划侧重于 HIV+ 和 HIV- 慢性病患者的 PO 风险缓解实践 pain，连同杰出的顾问和机构资源，将为指导和培训提供一个平台。扩展我的技能。使用我现有的研究队列和新的主要数据收集，包括定性数据通过访谈和离散选择实验，我们提出以下新的研究目标：1）检验 HIV+ 和 HIV- 慢性疼痛患者 PO 逐渐减少的积极和消极结果，以及 2) 确定 HIV+ 和 HIV- 慢性病患者对不同 PO 逐渐减少策略的偏好疼痛和高风险 PO 使用。所有拟议的研究都将与受训者一起进行，并将提供充足的为受训者提供多种研究方法、负责任的研究行为的发展机会，以及准备手稿和资助申请。研究结果将为未来的干预措施提供信息 PO 锥度指南。总体而言，拟议的指导、职业发展和研究计划将扩大应对阿片类药物流行病的能力。