Risks for Opioid Use and Abuse in Contrasting Chronic Pain Populations

描述（由申请人提供）：我们假设，越来越多地使用处方阿片类药物治疗精神健康障碍脆弱患者的慢性疼痛是阿片类药物滥用问题升级和阿片类药物使用的其他负面健康后果的主要原因。这项研究将分析2002-2007年的索赔数据从两个互补的来源：1] Highmark蓝盾私人保险计划（N= 350万），2]阿肯色州医疗补助（N= 660，000）我们将研究这些人与三个最常见的慢性非癌症疼痛的条件：背部疼痛，关节疼痛和头痛。2002年，Highmark的70多万人和Medicaid的10多万人因其中一种疼痛状况而就诊。2002年，Highmark慢性疼痛组中有4.9%（n= 34，819）和Medicaid慢性疼痛组中有12%（n= 12，263）接受了慢性阿片类药物治疗（>60天/年），为我们提供了超过250，000人-年的慢性疼痛患者慢性阿片类药物观察。这些数据集描述了两个具有地理和人口差异的群体，这些差异可能与阿片类药物使用的不同模式和阿片类药物滥用的不同风险有关。具体目的1）流行率/趋势：确定长期处方阿片类药物使用的流行率（> 60天/年），并对2002-2006年期间患有背痛、关节炎/关节痛和头痛的患者进行随时间变化趋势的检验2）开始：为了识别对这些慢性疼痛状况有新治疗发作的人，并随着时间的推移对其进行随访，使用考克斯比例风险模型评估慢性阿片类药物启动的预测因素。3)停药：在所有目前的慢性阿片类药物使用者中，使用考克斯比例风险模型来探讨阿片类药物停药的预测因素。4)阿片类药物滥用/误用：在曾经长期使用阿片类药物的患者中，使用logistic和Poisson回归模型研究以下预测因素：（a）确诊的阿片类药物滥用或依赖发作，（B）确诊的非阿片类药物滥用或依赖发作，（c）提示滥用的阿片类行为（多个药房或开处方者，>365天阿片样物质供应/年），（d）阿片样物质用途：使用的负面健康结果：死亡、住院、ER就诊、过量、损伤。5)药物滥用：在2002- 2006年期间所有背痛、关节炎/关节痛和头痛患者中，使用logistic和Poisson回归模型研究长期使用阿片类药物对以下发展的影响：（a）确诊的阿片类药物滥用或依赖发作，（B）确诊的非阿片类药物滥用或依赖发作6）风险分层：从2002-2006年数据中得出的模型将用于制定关于阿片类药物使用的风险分层程序，该程序将在研究的最后一年（2007年）进行验证。

DESCRIPTION (provided by applicant): We hypothesize that increasing use of prescribed opioids for chronic pain in vulnerable patients with mental health disorders is the primary reason for escalating problems with opioid abuse and other negative health consequences of opioid use. This study will analyze 2002-2007 claims data from two complementary sources: 1] Highmark-Blue Shield private insurance plan (N= 3.5 million), 2] Arkansas Medicaid (N=660,000) We will study those individuals with the three most common chronic non-cancer pain conditions: back pain, joint pain, and headaches. In 2002, over 700,000 individuals from Highmark and over 100,000 individuals from Medicaid had a visit for one of these pain conditions. In 2002, 4.9% (n=34,819) of this Highmark chronic pain group and 12% (n=12,263) of this Medicaid chronic pain group were prescribed chronic opioids (>60 days/year), offering us over 250,000 person-years of observation of patients with chronic pain on chronic opioids . These datasets describe two groups who have geographical and demographic differences that are likely associated with different patterns of opioid use and different risks for opioid abuse. Specific Aims 1) Prevalence/Trends: To determine prevalence rates of chronic prescription opioid use (> 60 days/year) for patients with back pain, arthritis/joint pain, and headaches during 2002-2006 and test for trends over time 2) Initiation: To identify persons with new treatment episodes for these chronic pain conditions, and follow them over time, using Cox proportional hazards models to assess predictors of chronic opioid initiation. 3) Discontinuation: Among all current chronic opioid users, to use Cox proportional hazards models to investigate the predictors of opioid discontinuation . 4) Opioid Abuse/Misuse: Among those who have ever been chronic opioid users, to use logistic and Poisson regression models to investigate predictors of: (a) Onset of diagnosed opioid abuse or dependence, (b) Onset of diagnosed non-opioid substance abuse or dependence, (c) Opioid behaviors suggestive of misuse (multiple pharmacies or prescribers, >365 days opioid supply/yr), (d) Negative health outcomes of opioid use: deaths, hospitalizations, ER visits, overdoses, injuries. 5) Substance Abuse: Among all patients with back pain, arthritis/joint pain, and headaches during 2002- 2006, to use logistic and Poisson regression models to investigate the effect of chronic opioid use on developing: (a) Onset of diagnosed opioid abuse or dependence, (b) Onset of diagnosed non-opioid substance abuse or dependence 6) Risk Stratification: Models derived from 2002-2006 data will be used to formulate risk stratification procedures concerning opioid use which will be validated in the final year (2007) of the study.