Identifying opportunities to reduce unnecessary opioid exposure and prevent iatrogenic addiction after outpatient surgery

确定减少不必要的阿片类药物暴露并预防门诊手术后医源性成瘾的机会

• 批准号: 9510873
• 负责人: Jessica C Young
• 金额: $ 7.39万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9510873
• 关键词: Accident and Emergency department; Acute Pain; Address; Age; Ambulatory Surgical Procedures; Analgesics; Antiepileptic Agents; Anxiety; Cessation of life; Characteristics; Chronic; Clinical; Comorbidity; Data; Databases; Dose; Effectiveness; Evidence based intervention; Food; Guidelines; Health; Healthcare; Heterogeneity; Iatrogenesis; Immunosuppression; Impaired cognition; Injury; Intervention; Length; Link; Mental Depression; Mental Health; Methods; Morphine; Operative Surgical Procedures; Opiate Addiction; Opioid; Opioid Analgesics; Overdose; Pain; Pain management; Participant; Patients; Pattern; Pharmaceutical Preparations; Physical therapy; Play; Population; Postoperative Pain; Postoperative Period; Principal Investigator; Procedures; Psychotherapy; Public Health; Reporting; Research; Risk; Role; Safety; Severities; Stress; Subgroup; Surgeon; Surgical complication; Therapeutic; Time; Translating; United States; Variant; Vulnerable Populations; Work; addiction; adverse outcome; analytical method; base; clinical practice; clinically relevant; cognitive function; cohort; combat; comorbid depression; data resource; demographics; dosage; experience; follow-up; high risk; insurance claims; milligram; mortality; multimodality; opioid abuse; opioid epidemic; opioid exposure; opioid overdose; opioid therapy; opioid use; overdose death; painful neuropathy; patient population; patient subsets; pill; prescription opioid; prevent; risk minimization; sex; treatment effect; vehicular accident

Principal Investigator (Young, Jessica, Carolyn): ABSTRACT The United States prescription opioid crisis is an ongoing public health concern. Since 2008, drug overdose deaths have been the leading cause of injury-related fatalities, outnumbering deaths due to motor vehicle accidents. The U.S. Food and Drug Commissioner recently stated the need to take immediate steps to address the rising toll of opioid addiction, stressing the importance of limiting lengths of opioid prescriptions to clinically relevant periods, and avoiding unnecessary opioid exposure leading to increased risk of addiction. Opioid analgesics play an important role in managing acute pain, such as that following outpatient surgery. However, patients often experience difficulty with opioid tapering and discontinuation, making prolonged opioid use the most common post-surgical complication. Long-term opioid therapy has been linked to dose escalation, increased sensitivity to pain, and increased risk of opioid addiction, abuse, and overdose. Many of those who go on to abuse opioid analgesics were first provided them in post-operative settings, and our preliminary data suggest that 75% of post-operative patients receive more dosage units than recommended by current clinical guidelines. Patient subgroups, such as those with mental health comorbidities, have reported higher levels of pain following surgery, and may be at increased risk of adverse consequences of opioid therapy. Understanding differences in prescribing to these patients and impacts of initial opioid prescriptions in this population is crucial as existing studies have suggested that these groups may be particularly vulnerable. Concurrent medications (e.g. gabapentinoids) and non-pharmacologic treatment (e.g. physical therapy, psychotherapy) may also modify the safety and effectiveness of opioids. The current project proposes to 1) describe differences in initial opioid prescription characteristics (length in days, quantity of pills, and total dosage dispensed) and concurrent use of multimodal analgesic therapies across patient subgroups, 2) estimate the effect of initial post-operative opioid prescribing on risk of long-term opioid use, opioid poisoning, and opioid addiction across a broad range of outpatient surgeries, and 3) identify vulnerable populations at higher risk of developing long-term use. This research will directly address two key clinical questions. First, our research will inform the treatment of post-surgical pain in opioid naïve patients to reduce the progression of iatrogenic opioid-related problems. Second, we will provide evidence to identify concurrent medications and non-pharmacologic treatment that may modify the risks associated with opioid use in the post-operative setting. This work is timely and will identify patterns in opioid prescribing that can be translated into meaningful interventions targeted at reduced long-term opioid use and the serious sequelae thereof.

首席调查员(杨、杰西卡、卡罗琳)： 摘要 美国处方阿片类药物危机是一个持续的公共卫生问题。自2008年以来，吸毒过量 死亡一直是与伤害相关的死亡的主要原因，死亡人数超过了机动车造成的死亡人数 意外事故。美国食品和药物专员最近表示，需要立即采取措施解决 阿片成瘾人数的上升，强调了限制阿片类药物处方长度仅限于临床的重要性 相关时期，避免不必要的阿片类药物暴露导致成瘾风险增加。 阿片类镇痛剂在治疗急性疼痛方面发挥着重要作用，例如门诊手术。 然而，患者经常遇到阿片类药物逐渐减少和停用的困难，使阿片类药物持续时间延长。 使用最常见的手术后并发症。长期的阿片类药物治疗与剂量有关 病情升级，对疼痛的敏感性增加，阿片成瘾、滥用和过量服药的风险增加。许多. 那些继续滥用阿片类止痛药的人首先是在手术后的环境中被提供的，我们的 初步数据显示，75%的术后患者接受的剂量单位超过了 目前的临床指南。 患者亚组，如那些患有精神健康合并症的患者，报告的疼痛程度更高。 手术后，可能会增加阿片类药物治疗不良后果的风险。理解 这些患者的处方差异和最初阿片类药物处方的影响在这一人群中是至关重要的 因为现有的研究表明，这些群体可能特别脆弱。同时服药 (如加巴喷丁)和非药物治疗(如物理治疗、心理治疗)也可 修改阿片类药物的安全性和有效性。 目前的项目建议1)描述最初的阿片类药物处方特征的差异(长度为#年 天数、药量和分配的总剂量)和同时使用多种模式的止痛疗法 跨患者分组，2)评估术后最初阿片类药物处方对长期风险的影响 在广泛的门诊手术中使用阿片类药物、阿片类药物中毒和阿片成瘾，以及3)确定 长期使用的风险较高的弱势人群。 这项研究将直接解决两个关键的临床问题。首先，我们的研究将为治疗提供信息 阿片类药物幼稚患者手术后疼痛减轻医源性阿片类药物相关问题的进展。 其次，我们将提供证据，以确定同时使用药物和非药物治疗的情况 可能会改变与术后使用阿片类药物相关的风险。这项工作是及时的，也将是 确定阿片类药物处方中可转化为有意义的干预措施的模式，以减少 长期使用阿片类药物及其严重后遗症。