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

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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.