Preventing Opioid Misuse through Safe Opioid Use Agreements between Patients and Surgical Providers (PROMISE ME)

通过患者和手术提供者之间的安全阿片类药物使用协议防止阿片类药物滥用 (PROMISE ME)

• 批准号: 10375426
• 负责人: Jonah James Stulberg
• 金额: $ 40.53万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10375426
• 关键词: Preventing; Opioid; Misuse; through; Safe

1 In 2017, 191 million opioid prescriptions were dispensed in the United States of which a 2 significant portion were prescribed for acute pain management following surgical encounters. In 3 addition, on average, 70% to 90% of prescribed opioid pills following surgery remain unused 4 and over 70% of surgery patients do not dispose of their unused opioids. Unused pills are a 5 common source of nonmedical use; 54% of people obtain their pills for nonmedical use through 6 friends or relatives and 35% through their healthcare provider. Nonmedical use of opioids can 7 lead to Adverse Drug Events (ADEs), and is frequently a pathway to the use of other, illicit, 8 drugs such as heroin. Our research team is currently funded by the National Institute on Drug 9 Abuse (NIDA) to develop methods for decreasing opioid prescribing in surgery, and through this 10 ongoing research we have identified that even after decreasing the number of pills prescribed a 11 large number of pills still go unused. Given the variation in individual patient use and the 12 provider's desire to provide adequate pain control to all of her patients, this will likely continue to 13 be the case for the foreseeable future. Furthermore, very few patients safely store their opioid 14 pills or dispose of them correctly, even when provided information on the importance and 15 methods for taking appropriate action. As we consider the next phase of improving our opioid 16 prescribing practices, decreasing the number of pills prescribed cannot be the end of our best 17 practices recommendations but rather the beginning. Effective prevention of harm caused by 18 prescription opioids requires patients to safely use pills; using only the minimum needed to 19 control pain, safely storing them, and appropriately disposing of unused pills after acute pain 20 treatment. 21 This study, Preventing Opioid Misuse through Safe Opioid Use Agreements 22 between Patients and Surgical Providers (PROMISE ME), will test the use of contractual 23 agreements to improve safe opioid use to prevent misuse and opioid-related harm. We will (1) 24 assess the barriers and facilitators to implementing opioid use agreements in the surgical 25 setting, (2) measure implementation effectiveness outcomes and provide real-time improvement 26 strategies while we (3) test the effectiveness of the intervention using a step-wedged cluster 27 randomized trial. The study will have a significant impact on prescription abuse as it directly 28 addresses the availability of excess prescription opioids within the community which is the 29 primary source of misuse and harm. We will disseminate the new knowledge generated from 30 this study throughout our 56-hospital learning collaborative

1 2017年，美国共开出1.91亿张阿片类药物处方，其中 2大部分用于外科手术后的急性疼痛治疗。在……里面 此外，平均70%至90%的手术后处方阿片类药物仍未使用 4超过70%的手术患者没有处理他们未使用的阿片类药物。未使用的药片是一种 5非医疗用途的常见来源；54%的人通过以下途径获得非医疗用途的药物 6个朋友或亲戚，35%通过他们的医疗保健提供者。阿片类药物的非医疗用途可能 7导致不良药物事件(ADE)，并经常是使用其他非法、 海洛因等8种毒品。我们的研究团队目前是由国家药物研究所资助的 9滥用(NIDA)开发减少手术中阿片类药物处方的方法，并通过 10我们正在进行的研究发现，即使减少了开出的药片数量， 大量的药片仍未使用。考虑到个别患者使用的不同以及 12提供者希望为她的所有患者提供足够的疼痛控制，这可能会继续 13在可预见的未来是这样的。此外，很少有患者安全地储存他们的阿片类药物 14药丸或正确处置它们，即使提供了关于重要性和 采取适当行动的15种方法。当我们考虑下一阶段改进我们的阿片类药物时 开处方的做法，减少开出的药片的数量不会是我们最好的结果 17实践建议，而不是开始。有效预防因 18种处方阿片类药物要求患者安全使用药物；仅使用所需的最低限度 19控制疼痛，安全储存，急性疼痛后适当处置未使用的药片 20个疗程。 21这项研究，通过安全阿片类药物使用协议防止阿片类药物滥用 22在患者和手术提供者之间(Promise ME)，将测试合同的使用 23项改善阿片类药物安全使用以防止滥用和阿片类药物相关伤害的协议。我们将(1) 24评估在外科手术中执行阿片类药物使用协议的障碍和促进者 25设置，(2)衡量执行效果结果并提供实时改进 26种策略，同时我们(3)使用阶梯楔形集群测试干预的有效性 27例随机对照试验。这项研究将对处方滥用产生重大影响，因为它直接 28解决社区内过量处方阿片类药物的供应问题，即 29误用和危害的主要来源。我们将传播由以下方面产生的新知识 30这项研究贯穿了我们56家医院的协作学习