Providers and Older Pain Patients with Prescription Opioid Dependence: A Qualitative Study to Understand Barriers to Opioid Taper, Cessation, and Transition to Buprenorphine.

具有处方阿片类药物依赖性的提供者和老年疼痛患者：一项定性研究，旨在了解阿片类药物逐渐减少、戒断和过渡到丁丙诺啡的障碍。

• 批准号: 10671358
• 负责人: Richard A Grucza
• 金额: $ 41.66万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2025-09-18
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10671358
• 关键词: Accidents; Address; Adult; Age; Age Years; Age-associated memory impairment; Aging; Agreement; Androgens; Applications Grants; Area; Awareness; Belief; Brain; Buprenorphine; Central Nervous System Depressants; Chronic; Clinical Sciences; Consensus; Data; Data Analyses; Dependence; Developed Countries; Drug abuse; Effectiveness; Elderly; Ensure; Evidence based intervention; Foundations; Fracture; Future; Goals; Grant; Guidelines; Health; Health system; Heart Diseases; Heavy Drinking; Heroin; Hormonal; Hyperalgesia; Illinois; Incentives; Intervention; Interview; Knowledge; Maintenance Therapy; Measures; Medicare; Mental Depression; Mental disorders; Metabolic; Methodology; Missouri; Observational Study; Opiate Addiction; Opioid; Opioid Analgesics; Outcome; Overdose; Pain intensity; Pain management; Patients; Pharmaceutical Preparations; Physiological; Polypharmacy; Population; Primary Care; Provider; Qualitative Methods; Randomized, Controlled Trials; Reporting; Research; Rewards; Risk; Silver; Testing; Time; Tsunami; Withdrawal; adverse outcome; age group; age related; age related cognitive change; aging population; behavioral health; buprenorphine treatment; chronic pain; chronic pain management; chronic painful condition; diagnostic criteria; drug metabolism; experience; falls; follow-up; illicit opioid; improved; interest; medication for opioid use disorder; non-cancer pain; novel; older patient; opioid overdose; opioid tapering; opioid use; opioid use disorder; opioid user; overdose death; pain patient; pain reduction; patient oriented; poor health outcome; prescription opioid; prescription opioid addiction; primary care practice; primary care provider; primary care setting; response; side effect; tool

Project Abstract Following the release of the CDC’s opioid prescribing guidelines, there has been a decrease in new prescription opioid analgesic use (OAU). Yet, whether and how to taper, stop prescribing, or transition to buprenorphine for older patients (≥50) is unclear. Many older patients have become chronic prescription opioid users. Thought leaders in opioid research agree that there is a dearth of studies specific to older patients, and that this hinders clinical science and interventions. We are unaware of studies of patient or provider beliefs regarding opioid cessation, taper, or transition to buprenorphine that are specific to older patients. While both patients and providers recognize dependence risk, the numerous other adverse health outcomes associated with chronic OAU, such as incident heart disease, new onset and worsening depression, hyperalgesia androgen deficiency, and changes in brain areas associated with reward, are less well known. Older adults are also unlikely to be aware of the potential for fatal overdose related to decreased ability to metabolic changes, age-related cognitive impairment and other factors associated with aging. Thus, even if older patients are not misusing, the health consequences of chronic OAU and lack of evidence for the efficacy of chronic OAU should lead to patient-provider discussions of taper, cessation, and possible transition to buprenorphine. This R21 proposal will utilize qualitative methods to obtain novel and foundational measures of older, chronic OAU patients’ and their providers’ perceived barriers and facilitators to taper, transition to buprenorphine and opioid cessation. This will lay the foundation for a subsequent intervention-oriented grant. Specific aims will: 1) determine barriers and facilitators to opioid taper, cessation and/or initiating buprenorphine among older patients (50+ year) with >1 year of OAU for non-cancer pain from diverse primary care practices in a large Midwestern health system; 2) determine barriers and facilitators experienced by primary care providers from diverse primary care practices, both with and without experience prescribing buprenorphine in opioid tapering, cessation or initiating buprenorphine among older patients (50-75 years old) with >1 year of OAU for non- cancer pain, and 3) compare and contrast patient and provider perspectives of barriers and facilitators in Aims 1 and 2 to elucidate where treatment goals are aligned and misaligned, by interviewing patient-provider dyads. The novel findings from our study will be used in a subsequent intervention to be developed and trialed in a follow-up R01. Our long-term goal is to provide an intervention for older patients and their providers in primary care settings to reduce or stop multi-year, continuous OAU.

项目摘要 在发布疾病预防控制中心的阿片类药物处方指南之后，新的 处方Ooid镇痛药（OAU）。但是，无论是以及如何逐渐锥度，停止开处方还是过渡到 老年患者的丁丙诺啡（≥50）尚不清楚。许多老年患者已成为慢性处方OOID 用户。阿片类研究协议中的思想领袖，即对老年患者的研究死亡，以及 这阻碍了临床科学和干预措施。我们不知道对患者或提供者信念的研究 考虑阿片类药物戒烟，锥度或过渡到特定于老年患者的丁丙诺啡。两者兼而有之 患者和提供者认识到依赖风险，以及许多其他不良健康结果 与慢性OAU一样，例如入射心脏病，新发作和遗憾抑郁症，痛风 雄激素缺乏症以及与奖励相关的大脑区域的变化鲜为人知。老年人是 同样不可能知道与代谢变化能力降低有关的致命过量的潜力， 与年龄相关的认知障碍和与衰老相关的其他因素。即使老年患者不是 滥用慢性OAU的健康后果以及缺乏慢性OAU效率的证据 应导致患者提供锥度，戒烟和可能过渡到丁丙诺啡的讨论。这 R21提案将利用定性方法获得较旧的慢性OAU的新颖和基础措施 患者及其提供者的感知障碍和促进者逐渐变细，过渡到丁丙诺啡和阿片类药物 停止。这将为随后的面向干预的赠款奠定基础。具体目标将：1） 确定阿片类锥度，停止和/或启动丁丙诺啡的障碍和促进因子 患者（50岁以上），OAU> 1年，可在大型的潜水员初级保健实践中进行非癌症疼痛 中西部卫生系统； 2）确定初级保健提供者经历的障碍和促进者 无论有没有经验的经验，都有在阿片类药物逐渐减少的情况下开出丁丙诺啡的各种基础习惯， 老年患者（50-75岁）的停止或启动丁丙诺啡，非OAU> 1年 癌症疼痛以及3）AIMS的障碍和促进者的比较和对比患者以及提供者的观点 1和2通过采访患者支持者的二元组，以阐明对治疗目标的对齐和错位的位置。 我们研究的新发现将用于在随后的干预措施中进行开发和试用 后续R01。我们的长期目标是为老年患者及其主要提供者提供干预措施 护理设置减少或停止多年连续的OAU。