Transporting treatment effects from clinical trials to real-world populations with co-occurring opioid and stimulant use disorders

项目概要和摘要 在美国，阿片类药物过量导致的死亡人数现在是车祸死亡人数的两倍 国家。处方阿片类药物和海洛因相关死亡率令人鼓舞的下降趋势已经黯然失色 由于合成阿片类药物和同时使用阿片类药物导致的用药过量和死亡人数增加， 兴奋剂。在全国范围内，兴奋剂和阿片类药物的联合使用在过去十年中几乎增加了一倍，并且 西方各州增加了两倍多。至少一半患有阿片类药物使用障碍 (OUD) 的人还有另一种情况 物质使用障碍（SUD），多种物质使用是临床常态。虽然有几个功效 SUD（包括 OUD）的治疗方法已在严格的随机对照试验 (RCT) 中确立， 参加这些随机对照试验的人群通常与这些治疗的目标人群不同。在 特别是，几乎没有证据支持当前 SUD 治疗对于使用多种药物的人的有效性 物质。因此，了解和增强 SUD 治疗对患有以下疾病的人的效果 多物质的使用仍然是 NIDA 的优先领域 (PAR-20-035)。拟议的研究解决了这个关键问题 通过将尖端数据科学方法与创新数据融合技术相结合来弥补知识差距， 可运输性，以估计 SUD 治疗试验如果进行的话会产生什么结果 在具有 OUD 和兴奋剂使用障碍 (OUD 刺激UD）。在目标 1 中，我将国家药物滥用治疗临床试验网络 RCT 的数据与 全国药物使用与健康调查。我估计药物的有效性、应急措施 管理、动机访谈、咨询和锻炼，以提高治疗的开始率和保留率 减少使用 OUD 的美国成人、平民、非机构化人群中阿片类药物和兴奋剂的使用 刺激UD。在我的第二个目标中，我将相同的临床试验数据与电子健康记录融合起来，以估计 提高 OUD 患者治疗参与度和保留率的干预措施的有效性 俄勒冈健康与科学大学卫生系统中的 StimUD。通过完成这些目标，我估计 OUD StimUD 患者治疗的真实效果。临床医生和政策制定者可能 使用结果来指导治疗选择，以改善这些复杂、脆弱患者的健康。 通过这个奖项，我凭借自己在流行病学和统计学方面的背景，获得了以下领域的专业知识： 边缘数据科学和信息学方法。结合因果推理、机器学习和自然 语言处理技术最大限度地提高了我的研究的创新性、有效性、影响力和影响力。我也 接受临床成瘾医学方面的广泛指导，并培养我的领导力、拨款写作和科学能力 沟通技巧。这些新技能中的每一项对于完成我的研究目标和发展都至关重要 未来高影响力、高度竞争的研究提案，带来成功的独立研究生涯 在成瘾科学中。

PROJECT SUMMARY AND ABSTRACT Opioid-related overdoses are now responsible for twice as many deaths per year as car accidents in the United States. Encouraging downward trends in prescription opioid- and heroin-related mortality have been eclipsed by rises in overdoses and deaths attributable to synthetic opioids and concomitant use of opioids and stimulants. Nationally, the combined use of stimulants and opioids has nearly doubled in the past decade, and more than tripled in Western states. At least half of individuals with opioid use disorder (OUD) have another substance use disorder (SUD), and polysubstance use is the clinical norm. Although the efficacy of several treatments for SUDs, including OUD, has been established in rigorous randomized controlled trials (RCTs), the people enrolled in these RCTs often differ from the populations those treatments are intended to reach. In particular, little evidence supports the effectiveness of current SUD treatments for people who use multiple substances. Consequently, understanding and enhancing the effects of SUD treatments for people with polysubstance use remains a NIDA priority area (PAR-20-035). The proposed research addresses this critical knowledge gap by combining cutting-edge data science methods with an innovative data-fusion technique, transportability, to estimate what the results of SUD treatment trials would have been had they been conducted in representative, clinically-relevant populations of individuals with OUD and stimulant use disorders (OUD + StimUD). In Aim 1, I fuse data from National Drug Abuse Treatment Clinical Trials Network RCTs with the National Survey on Drug Use and Health. I estimate the effectiveness of medications, contingency management, motivational interviewing, counseling, and exercise to increase treatment initiation and retention and reduce opioid and stimulant use in the adult, civilian, noninstitutionalized U.S. population with OUD + StimUD. In my second Aim, I fuse the same clinical trial data with electronic health records to estimate the effectiveness of interventions to increase treatment engagement and retention among patients with OUD + StimUD in the Oregon Health & Science University health system. Through completing these aims, I estimate the real-world effectiveness of treatments for individuals with OUD + StimUD. Clinicians and policymakers may use the results to guide treatment selection to improve the health of these complex, vulnerable patients. Through this award, I build upon my background in epidemiology and statistics to gain expertise in cutting- edge data science and informatics methods. Combining causal inference, machine learning, and natural language processing techniques maximizes the innovation, validity, impact, and reach of my research. I also receive extensive instruction in clinical addiction medicine and build my leadership, grant writing, and scientific communication skills. Each of these new skills are crucial to completing my research aims and developing future high-impact, highly competitive research proposals leading to a successful independent research career in addiction science.