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Building and Implementing Best Practices for Buprenorphine Initiation in the Setting of Fentanyl Use

在芬太尼使用情况下建立和实施丁丙诺啡起始的最佳实践

基本信息

批准号：
10721763
负责人：
Elenore Bhatraju
金额：
$ 18.8万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-15 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10721763
关键词：
Absence of pain sensation Award Awareness Buprenorphine Caring Certification Cessation of life Clinical Communities Complex Consensus Counseling Country Data Data Collection Dose Effectiveness Enrollment FDA approved Failure Feedback Fentanyl Funding Future Goals Hospitals Individual Inpatients Interview Life Literature Medical center Methadone Methods Morbidity - disease rate Naltrexone Nature Opioid Opioid agonist Outcome Outpatients Patient Care Patients Penetration Persons Pharmaceutical Preparations Phase Physicians Pilot Projects Practice Guidelines Preparation Prevalence Procedures Process Provider Qualitative Methods Qualitative Research Randomized Reaction Research Research Methodology Research Personnel Research Support Research Training Review Literature Risk Rural Safety Secondary to Substance Use Disorder Time Training Treatment Failure Ventilatory Depression Waiting Lists Withdrawal Work addiction career effectiveness/implementation study evidence base experience feasibility testing fentanyl use implementation barriers implementation evaluation implementation facilitators implementation science improved improved outcome innovation lipophilicity medication for opioid use disorder mortality multidisciplinary novel opioid use opioid use disorder overdose death preference provider factors recruit relative effectiveness response safety net tool virtual

项目摘要

PROJECT SUMMARY Morbidity and mortality related to opioid use continue to rise, with fentanyl now the most common opioid involved in overdose death. Despite three FDA approved medications for opioid use disorder (MOUD)—methadone, buprenorphine, and naltrexone--as many as 3 out of 4 people with OUD are not on any of these lifesaving medications, which speaks to failures in implementation. The penetration of fentanyl into the opioid supply has made strategies for initiation of buprenorphine even more complex. Growing literature describes increased precipitated withdrawal at the time of buprenorphine initiation, thought to be secondary to the lipophilic nature of fentanyl. There is an urgent need to better understand how we can successfully engage more people in treatment that we know decreases morbidity and mortality related to OUD. The work proposed in this K23 application will investigate the initiation of buprenorphine in the setting of fentanyl use from both the patient and provider perspectives. We will utilize novel methods to develop a buprenorphine initiation toolkit and then will pilot the implementation of this new tool. The specific aims of the research are to: 1. Use qualitative methods to explore the experience of both patients and providers initiating buprenorphine for OUD in the setting of fentanyl use. 2a. Conduct a modified Delphi process to investigate expert consensus regarding buprenorphine initiation in the setting of fentanyl. 2b. Work with a multidisciplinary group to develop a buprenorphine initiation toolkit, and 3: Conduct a pilot study to evaluate the acceptability, feasibility and effectiveness of the buprenorphine initiation toolkit. Along with the multipronged training plan, this research will support my overarching goal of becoming an independent physician researcher focused on improving outcomes for people with substance use disorders through innovative implementation approaches.

项目摘要与阿片类药物使用相关的发病率和死亡率继续上升，芬太尼现在是最与过量死亡有关的普通阿片类药物。尽管FDA批准了三种阿片类药物使用障碍（MOUD）-美沙酮，丁丙诺啡和纳洛酮-多达4分之3 患有OUD的人没有服用任何这些救命药物，这说明了实施.芬太尼渗透到阿片类药物供应中，丁丙诺啡的启动更加复杂。越来越多的文献描述了在丁丙诺啡开始时突然戒断，被认为是继发于芬太尼的亲脂性。迫切需要更好地了解我们如何能够成功地让更多的人参与治疗，我们知道，降低发病率和死亡率关于OUD本K23申请中提出的工作将调查从患者和提供者的角度来看，丁丙诺啡在芬太尼使用环境中的作用。我们将利用新方法开发丁丙诺啡启动工具包，然后将试点使用这个新工具。本研究的具体目的是：1.使用定性方法探讨患者和供应商开始丁丙诺啡的经验，芬太尼使用环境中的OUD。2a.执行修改后的德尔菲程序，调查专家关于在芬太尼环境中开始丁丙诺啡的共识。2b.工作与多学科小组开发丁丙诺啡启动工具包，3：开展试点研究评价丁丙诺啡启动工具包的可接受性、可行性和有效性。沿着多管齐下的培训计划，这项研究将支持我的总体目标，成为一名独立的医生研究员，专注于改善患有通过创新的实施方法来治疗药物使用障碍。