The Ohio Valley Node of the Clinical Trials Network

公共卫生摘要 阿片类药物使用障碍（MOUD），如美沙酮，丁丙诺啡（与或 无纳洛酮）和缓释纳洛酮，已被证明可以减少过量服用 和吸毒然而，保留MOUD对于实现这些结果至关重要。 不幸的是，只有50%或更少的患者在开始治疗后6个月仍在使用MOUD， 国家质量论坛制定的最低标准。的一种可能的方法 改善保留将使用患者特征来选择MOUD， 患者最有可能成功。本研究将利用VHA数据集识别患者 按MOUD类型和患者列出的与改善MOUD保留相关的特征 与成功MOUD停药无复发相关的特征。我们将使用一个 采用国际疾病分类第9版和第10版的回顾性队列设计 （ICD-9/10-CM）代码，以操作OUD，因为用于本研究的数据年份交叉 在ICD-10实施期间（2015年）。目标1：确定患者特征 与MOUD保留和阿片类药物过量死亡相关。我们的首要 目标1的结果将是保留的二元衡量标准，定义为连续覆盖， 患者最初在索引日期后180天开始的MOUD类型，没有28- 治疗的间隙。次要结局指标将包括（1） 保持与主要结局相似，但在索引日期后超过365天，以及（2） 使用VHA死亡率数据的索引日期后365天内阿片类药物过量死亡 仓库。目的2是量化MOUD后复发概率 停药时间和MOUD治疗时间以及患者特征。的结局 目标2将是有与无复发的停药。

PUBLIC HEALTH ABSTRACT Medications for Opioid Use Disorder (MOUD), such as methadone, buprenorphine (with or without naloxone), and extended-release naltrexone, have been shown to reduce overdoses and drug use. However, MOUD retention is essential to attaining these outcomes. Unfortunately, only 50% or less of patients remain on MOUD 6 months after initiating treatment, a minimum standard established by the National Quality Forum. One possible approach to improving retention would be using patient characteristics to select the MOUD with which patients are most likely to be successful. This study will utilize VHA data sets to identify patient characteristics associated with improved MOUD retention by MOUD type as well as patient characteristics associated with successful MOUD discontinuation without relapse. We will use a retrospective cohort design using the International Classification of Disease, 9th and 10th edition (ICD-9/10-CM) codes to operationalize OUD since the years of data used for this study cross over the time of ICD-10 implementation (2015). Aim 1 is to identify patient characteristics associated with MOUD retention and opioid overdose death by MOUD type. Our primary outcome for Aim 1 will be a binary measure of retention defined as continuous coverage with the type of MOUD the patient originally initiated for 180 days after the index date without a 28- day gap in treatment. Secondary outcome measures will include (1) a binary measure of retention similar to the primary outcome but over the 365 days after the index date and (2) opioid overdose death in the 365 days after the index date using the VHA Mortality Data Repository. Aim 2 is to quantify the association between probability of relapse after MOUD discontinuation and both length of MOUD therapy and patient characteristics. The outcome for Aim 2 will be discontinuation with vs. without relapse.