Addressing the prescription opioid crisis from the provider side- optimizing research and intervention design for maximum impact on public health

摘要 骨科医生是阿片类药物处方的第三大内科医生。中的学术出版物 肌肉骨骼疾病和损伤领域充斥着概述地方和专科的手稿 有重点地努力减少这些药物的使用，并确定有长期滥用风险的患者。 干预措施通常是被禁止的，只相对于它开发的地点，缺乏 适当的实验设计和不可伸缩。同样，提交的大型数据集分析检查 阿片类药物的使用并不是为了识别有慢性阿片类药物滥用风险的患者的特征而设计的。我们 计划在阿片类药物管理领域召集一组积极的调查员，包括代表 来自肌肉骨骼医学和外科的主要科学出版物的编辑人员，以确定 优化研究设计以解决优化低风险和高风险阿片类药物处方模式的问题 患者并开发分析方法以应用于大型管理数据集以识别处于风险中的个人 因为长期虐待。这次为期一天的会议的目标与NIAMS指导的RFA机制是一致的， 疼痛研究中的模型、测量和管理(PA 18-159、18-141)以及NIH Hear 这两项倡议都涉及NIH的其他机构。会议结束时，可交付成果如下：(I) 跨子专业和肌肉骨骼状况处理这一问题的最佳研究设计 并且可以跨大型医疗保健系统进行扩展，以及(Ii)针对大型数据集的分析方法 来识别高危患者。会议座谈会将发表在《骨与关节外科杂志》上 补充并与NIAMS分享。

ABSTRACT Orthopaedic surgeons are the 3rd largest physician opioid prescribing group. Scholarly publications in the musculoskeletal disease and injury field have been inundated with manuscripts outlining local and subspecialty focused attempts to decrease the use of these medications and to identify patients at risk of chronic abuse. The interventions are generally are proscriptive, relative only to the site where it was developed, lacking in appropriate experimental design and un-scalable. Similarly, submitted analyses of large data sets examining opioid use are not optimally designed to identify characteristics of patients at risk for chronic opioid abuse. We plan to assemble a group of active investigators in the area of opioid management, including representatives from the editorial staffs of the major scientific publications in musculoskeletal medicine and surgery, to identify optimum research designs to address the issues of optimizing opioid prescribing patterns for low and high-risk patients and develop analytic approaches to apply to large administrative data sets to identify individuals at risk for chronic abuse. The goals of this one-day meeting are in line with NIAMS directed RFA’s Mechanisms, Models, Measurement and Management in Pain Research (PA 18-159, 18-141) as well as the NIH HEAL initiative both of which involve other NIH agencies. At the end of the meeting, the deliverables will be (i) optimum research designs which approach the issue across subspecialties and musculoskeletal conditions and which can be scalable across large health care systems, and (ii) analytic approaches for large data sets which identify at-risk patients. The meeting symposia will be published in a Journal of Bone and Joint Surgery supplement and shared with NIAMS.