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 随着疾病预防控制中心阿片类药物处方指南的发布，新的 处方阿片类止痛剂使用(非统组织)。然而，是否以及如何缩减、停止开处方或过渡到 丁丙诺啡对老年患者的作用(≥50)尚不清楚。许多老年患者已成为慢性处方阿片类药物 用户。阿片类药物研究的思想领袖同意，缺乏专门针对老年患者的研究，而且 这阻碍了临床科学和干预。我们没有意识到关于患者或提供者信念的研究 关于阿片类药物的停止、减少或过渡到丁丙诺啡，这是老年患者特有的。虽然两者都 患者和提供者认识到依赖风险，以及与之相关的许多其他不良健康后果 患有慢性非统组织，如突发心脏病、新发和恶化的抑郁症、痛觉过敏 雄激素缺乏，以及与奖励相关的大脑区域的变化，则不太为人所知。年纪较大的人 也不太可能意识到与代谢变化能力下降有关的致命过量的可能性， 与年龄相关的认知障碍和其他与衰老相关的因素。因此，即使年龄较大的患者没有 滥用、慢性非统组织的健康后果以及缺乏证据证明慢性非统组织的疗效 应导致患者-提供者讨论逐渐减少，停止，以及可能过渡到丁丙诺啡。这 R21提案将利用定性方法，以获得较老的、长期的非统组织的新的基本措施 患者和他们的提供者对逐渐减少、过渡到丁丙诺啡和阿片类药物的感知障碍和促进者 停止。这将为随后以干预为导向的赠款奠定基础。具体目标将：1) 在老年人中确定减少阿片类药物、停止和/或启动丁丙诺啡的障碍和促进剂 非癌性疼痛患者(50年以上)接受非统组织一年的治疗，主要来自不同的初级保健实践 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 不同的初级保健做法，无论是否有在阿片类药物逐渐减少时开出丁丙诺啡的经验， 在50-75岁的老年患者中停用或开始丁丙诺啡；非非统组织1年 癌症疼痛，以及3)比较和对比患者和提供者在AIMS中障碍和促进者的观点 1和2通过采访患者-提供者二人组来阐明治疗目标在哪里一致和不一致。 我们研究的新发现将被用于后续的干预措施，并将在 后续R01。我们的长期目标是为老年患者和他们的提供者提供初级干预 护理环境，以减少或停止多年、持续的非统组织。