The Impact of Pharmaceutical Industry Messaging on the Opioid Crisis among U.S. Military Veterans

摘要/项目摘要 了解制药业在推动美国当前阿片类药物危机中的作用是一个重要的问题。 预防未来流行病的基本战略。使用多种形式的文本数据和创新 数据挖掘和三角测量的方法，该项目研究了行业努力的具体影响， 将退伍军人作为阿片类药物消费者，并分析新的行业驱动的叙事，或脚本， 关于阿片类镇痛药的信息退伍军人有许多弱点， 受阿片类药物危机和阿片类药物相关危害影响最严重，包括过量和HIV/HCV 感染针对制药公司的诉讼中出现的重要文件表明， 退伍军人被定位为一个重要的消费者利基通过倡导团体和付费帐户， 关于阿片类药物治疗的好处。然而，目前只有一小部分文件 在法律的发现过程中发现的问题已经被公共卫生研究人员研究过了， 目前已知更广泛的行业议程和亲制药叙事成为 退伍军人特定健康话语的一部分，推动对阿片类药物的态度，并提高对非阿片类药物疼痛的障碍 管理为了确定主题并阐明这些脚本被内化的过程， 不同的退伍军人群体，这种混合方法的研究将三角形的大型数据集的药物 行业营销和法律的文件与退伍军人为主题的出版物和生活经验， 慢性疼痛患者研究结果将转化为对疼痛管理产生积极影响的可交付成果 政策，实践，以及慢性疼痛退伍军人的态度和期望。科学团队包括 退伍军人和科学家站在揭露烟草业如何针对军事人员的最前沿， 退伍军人，沿着还有阿片类药物使用和制药行业诉讼方面的专家。系统的文本和 本研究中的内容分析代表了制药行业努力改变的关键案例研究 规定政策和流行文化，并将作为一个重要的贡献，文学的自然 通过实现以下目标，了解药物危机的历史和疼痛的临床方法： 目标1：利用文本挖掘技术和烟草研究人员改进的分析方法， 制药业的运动，以影响退伍军人（和退伍军人服务组织）的看法 阿片类药物治疗，特别是在慢性疼痛管理的背景下。 目标2：对有疼痛和阿片类药物使用史的退伍军人进行定性访谈，以了解 社会文化意义和认知脚本，阻碍安全，有效和医疗适当的护理。 目标3：基于目标1和2的数据合成，进行T0和T1转化研究，以生成 具体的最佳实践、工具和网络资源，以指导临床和开处方者与退伍军人的接触 和其他慢性疼痛人群。

Abstract/Project Summary Understanding the role of the pharmaceutical industry in propelling the current opioid crisis in the U.S. is an essential strategy for preventing future epidemics. Using multiple forms of textual data and innovative methodologies for data mining and triangulation, this project examines the specific impacts of industry efforts to target military veterans as opioid consumers and analyzes how new industry-driven narratives, or scripts, about opioid analgesics were circulated. Veterans have many vulnerabilities and are one of the populations most severely impacted by the opioid crisis and opioid-related harms, including overdose and HIV/HCV infection. Important documents emerging in litigation against pharmaceutical companies establish that veterans were targeted as an important consumer niche through advocacy groups and paid accounts from veterans about the benefits of opioid therapies. However, only a small portion of the documents currently being revealed in the process of legal discovery have been examined by public health researchers, and very little is currently known about broader industry agendas and the processes by which pro-pharma narratives became part of veteran-specific health discourse, driving attitudes toward opioids and raising barriers to non-opioid pain management. To identify the themes and elucidate the processes by which these scripts were internalized by different veteran populations, this mixed-method research will triangulate large datasets of pharmaceutical industry marketing and legal documentation with veteran-themed publications and the lived experience of chronic pain patients. Findings will be translated into deliverables which positively impact pain management policy, practice, and the attitudes and expectations of veterans with chronic pain. The scientific team includes veterans and scientists at the forefront of uncovering how the tobacco industry targeted military personnel and veterans, along with experts on opioid use and pharmaceutical industry litigation. The systematic textual and content analyses in this study represent a critical case study in pharmaceutical industry efforts to change prescribing policy and popular culture and will serve as an important contribution to literature on the natural history of drug crises and to clinical approaches to pain by achieving the following aims: Aim 1: Use textual mining technology and analytic methods refined by tobacco researchers to explicate the pharmaceutical industry's campaign to influence veterans' (and veterans service organizations') perceptions opioid therapies, particularly within the context of chronic pain management. Aim 2: Conduct qualitative interviews among veterans with histories of pain and opioid use to understand sociocultural meanings and cognitive scripts that impede safe, effective, and medically-appropriate care. Aim 3: Based on a synthesis of data from Aims 1 and 2, conduct T0 and T1 translational research to generate concrete best practices, tools, and web resources to guide clinical and prescriber engagement with veteran and other chronic pain populations.