Pain, Multimorbidity, Opioid-Drug Interactions and Risk for Opioid Use Disorder or Overdose in Older Adults

老年人的疼痛、多重发病、阿片类药物相互作用以及阿片类药物使用障碍或过量的风险

• 批准号: 10659436
• 负责人: Yu-Jung Wei
• 金额: $ 40万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-10 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10659436
• 关键词: Pain; Multimorbidity; Opioid; Drug; Interactions

This study proposes longitudinal research among older adults to assess the associations of uncontrolled pain, co-occurring chronic conditions or geriatric symptoms (multimorbidity), and opioid–drug interactions with risk for opioid use disorder (OUD) or overdose (OD). This study is responsive to AHRQ’s special interest (NOT-HS- 21-010) in research to address substance use disorders, including OUD and OD in older adults. Older adults have experienced significant increases in OUD or OD in the last decade despite a decrease in the number of opioid prescriptions, signaling an urgent need to identify factors beyond prescription opioid use that contribute to OUD/OD to inform interventions in older populations. Pain, multimorbidity, and polypharmacy, all strongly associated with advancing age, are frequently noted as potential risk factors for OUD/OD in older adults, but relevant evidence is lacking. Relieving pain is the most frequent motive for opioid misuse in older adults, but to what extent uncontrolled pain contributes to risk for OUD/OD is unknown. Multimorbidity is highly prevalent in older adults with OUD or OD, but its association with uncontrolled pain and the joint association of multimorbidity and uncontrolled pain with risk for OUD/OD are unknown. There is also limited understanding regarding the risk of OUD/OD when prescription opioids for pain treatment are concurrently used with drugs for other chronic comorbid conditions that may interact with opioids in older adults. To fill these research gaps, this proposed study will leverage a 100% Medicare sample and Medicare data linked to nationally representative longitudinal survey data to study the associations of pain, multimorbidity, and opioid-drug interactions with risk for OUD/OD outcomes of older adults with chronic pain. Specifically, we will examine the associations between pain control and risk for OUD or OD in older adults diagnosed with chronic pain and treated with prescription opioids. We will also evaluate the association of multimorbidity with pain control and their joint association with OUD/OD risk in older patients. Furthermore, we will assess the extent to which concurrent use of opioids with drugs for treating common comorbid conditions with chronic pain in older adults is associated with OUD/OD outcomes in older adults with chronic pain. We will measure both pain and high-impact pain and quantify multimorbidity through both a diagnosis-based index and the presence of geriatric symptoms that are underdiagnosed or not diagnosable. Our study will provide empirical evidence on the extent to which uncontrolled pain, multimorbidity, and opioid-drug interactions may play a role in increasing risk for OUD or OD among older adults with chronic pain. Given the accelerated growth of the US aging population and the continuing increase in OUD, OD, and opioid misuse, our data will inform interventions that integrate care for chronic pain and other chronic comorbid conditions to improve pain control while reducing OUD or OD in older adults.

这项研究建议在老年人中进行纵向研究，以评估不受控制的疼痛， 同时发生的慢性疾病或老年症状（多发性硬化症），以及阿片类药物与风险药物的相互作用 用于阿片类药物使用障碍（OUD）或过量（OD）。这项研究是响应AHRQ的特别兴趣（NOT-HS- 21-010）在研究中解决物质使用障碍，包括老年人的OUD和OD。老年人 在过去的十年中，尽管人口数量减少，但OUD或OD仍显着增加。 阿片类药物处方，表明迫切需要确定处方阿片类药物使用以外的因素， 向OUD/OD提供信息，为老年人口的干预措施提供信息。疼痛，多发性硬化症，多种用药， 与年龄增长相关，经常被认为是老年人OUD/OD的潜在危险因素，但 缺乏相关证据。缓解疼痛是老年人滥用阿片类药物的最常见动机，但 不受控制的疼痛对OUD/OD风险的影响程度尚不清楚。多发性硬化症在以下国家非常普遍： OUD或OD的老年人，但其与不受控制的疼痛和 伴有OUD/OD风险的多发性和不受控制的疼痛尚不清楚。也有有限的理解 关于用于疼痛治疗的处方阿片类药物与用于治疗疼痛的药物同时使用时OUD/OD的风险， 在老年人中可能与阿片类药物相互作用的其他慢性共病。为了填补这些研究空白， 拟议的研究将利用100%的医疗保险样本和医疗保险数据， 纵向调查数据，以研究疼痛、多发性硬化和阿片类药物相互作用与风险的相关性 用于老年慢性疼痛患者的OUD/OD结局。具体来说，我们将研究 在诊断为慢性疼痛并接受以下治疗的老年人中，疼痛控制与OUD或OD风险之间的关系 处方阿片类药物我们还将评估多发性硬化症与疼痛控制的关系， 与老年患者的OUD/OD风险相关。此外，我们将评估同时使用 阿片类药物与治疗老年人慢性疼痛常见共病的药物的比例 与OUD/OD结果的关系。我们将测量疼痛和高冲击性疼痛， 通过基于诊断的指数和老年症状的存在来量化多发病， 诊断不足或无法诊断。我们的研究将提供经验证据， 不受控制的疼痛、多种吗啡和阿片类药物相互作用可能在增加OUD或OD风险中发挥作用 老年慢性疼痛患者中。鉴于美国老龄化人口的加速增长以及 OUD，OD和阿片类药物滥用的持续增加，我们的数据将为整合护理的干预措施提供信息， 慢性疼痛和其他慢性共病，以改善疼痛控制，同时减少老年人的OUD或OD 成年人了