Trends and racial/ethnic differences in opioid prescribing safety and use of nonpharmacologic treatments for chronic pain in adults with co-occurring opioid use disorder

在美国阿片类药物相关发病率和死亡率增加的情况下，安全、有效和 慢性疼痛的综合治疗是至关重要的。患有慢性疼痛共病的人， OUD以及少数种族和族裔群体由于其潜在的未得到充分对待， 疼痛和OUD，以及不良健康结果的风险增加。2016年，疾病控制中心 美国疾病预防控制中心（CDC）发布了一项突出的临床实践指南，强调非阿片类药物， 疼痛管理的非药物替代品，并建议在阿片类药物使用的情况下采取更安全的处方做法 用于治疗慢性疼痛慢性疼痛治疗模式随时间和年龄的变化 少数群体和同时发生OUD的人的弱势亚群需要了解和 解决慢性疼痛指南一致治疗中的健康差异。利用2015年， 2018年医疗保险登记数据结合住院，门诊和处方索赔数据， 20%的国家样本，建议研究的目的是：（1）评估种族和民族的差异类型 慢性疼痛治疗提供给患有OUD的人，和（2）评估是否 CDC指南的实施影响了慢性疼痛治疗中的种族/民族差异 对于那些与OUD。我们将疼痛治疗分为药物，非药物， 药理学和非药理学的结合。在这些处方阿片类药物中，我们将评估 处方的指南一致性，因为它涉及阿片类药物剂量和合并苯二氮卓类药物 处方我们假设患有OUD的少数种族/民族不太可能接受指南 一致的阿片类药物管理和非药物治疗比白色OUD慢性疼痛患者。我们 进一步预计在CDC阿片类药物释放后，慢性疼痛治疗的差异会恶化 指导方针。如果得到确认，我们将探索差异的潜在来源（例如，联合开纳洛酮， 疼痛和成瘾专家的参与），可以为改善慢性疼痛的干预措施提供信息 治疗那些同时发生的OUD。这项研究的长期目标是表征和 减少人们在接受推荐的护理标准和循证治疗方面的差异 慢性疼痛和口腔溃疡并存我们的发现将为更多的研究提供急需的证据。 有效和公平的公共卫生和健康保险政策，并可为未来的临床指南提供信息。

In the climate of increased opioid-related morbidity and mortality in the U.S., the safe, effective and comprehensive management of chronic pain is critically important. People with comorbid chronic pain and OUD and racial and ethnic minorities deserve specific attention due to their potential under-treatment of pain and OUD, and elevated risk of adverse health outcomes. In 2016, the Centers for Disease Control and Prevention (CDC) released a prominent clinical practice guideline that emphasizes non-opioid and non-drug alternatives for pain management, and recommends safer prescribing practices if opioids are prescribed to treat chronic pain. An examination of chronic pain treatment patterns over time and in vulnerable subgroups of minorities and people with co-occurring OUD is needed to understand and address health disparities in the delivery of guideline concordant treatment for chronic pain. Using 2015 to 2018 Medicare enrollment data combined with inpatient, outpatient and prescription claims data from a 20% national sample, the proposed research aims to: (1) assess racial and ethnic disparities in the types of chronic pain treatments provided to people with comorbid OUD, and (2) evaluate whether the implementation of the CDC guideline influenced racial/ethnic disparities in the treatment of chronic pain for those with OUD. We will categorize pain treatments as pharmacologic, non-pharmacologic, and combination of pharmacologic and non-pharmacologic. Among those prescribed opioids, we will assess the guideline concordance of prescribing as it relates to opioid dosage and concurrent benzodiazepine prescriptions. We hypothesize that racial/ethnic minorities with OUD are less likely to receive guideline concordant opioid management and non-drug therapy than White chronic pain patients with OUD. We further anticipate worsened disparities in chronic pain treatment following release of the CDC opioid guideline. If confirmed, we will explore potential sources of disparities (e.g., co-prescribing of naloxone, involvement of pain and addiction specialists) that could inform interventions to improve chronic pain treatment in those with cooccurring OUD. The long-term goal of this research is to characterize and reduce disparities in receipt of recommended standards of care and evidence-based treatment for people with co-occurring chronic pain and OUD. Our findings will provide much needed evidence for more effective and equitable public health and health insurance policy, and can inform future clinical guidelines.