SPOiLER: towards Safer Prescribing of Legal Opioids from the Emergency Room

项目摘要 本NIDA K08职业发展提案的目标是获得经验和培训， 成为一名独立的调查员，专注于发展循证实践，以预防和 在急诊科治疗药物滥用类阿片使用障碍，包括过量和 成瘾，在美国已经成为流行病。虽然研究主要集中在长期阿片类药物 在门诊处方，急诊科阿片类药物处方急性疼痛的条件， 未来患者不良结局的门户仍然定义不清。 包括马萨诸塞州在内的州政府已经对阿片类药物危机做出了反应， 部分是通过制定立法来广泛限制法律的阿片类药物处方。然而，阿片类药物仍然是一种 一些急性疼痛状况的重要治疗选择，以及基于证据的适当 处方缺乏，部分原因是影响提供者阿片类药物处方行为的因素， 后续患者相关不良结局仍未知。了解潜在的 影响阿片类药物处方行为和未来患者结局的因素，包括州立法， 行为，医院态度和当地文化，是发展综合的，基于证据的 这些建议侧重于改变围绕安全阿片类药物处方实践的文化。 使用计划行为理论作为框架，本K08补助金申请的目标是 通过以下目标了解阿片类药物处方行为和不良患者结局：首先，我们 将评估州立法的影响，特别是2016年马萨诸塞州（MA）阿片类药物法， 形成基于医院的法规和提供者对阿片类药物处方的感知态度， 对马萨诸塞州当地医生领导人进行定性访谈。其次，利用全面的索赔数据，我们将 评估2016年MA阿片类药物法对全州阿片类药物处方的影响，使用邻国 没有阿片类药物立法作为自然控制。最后，我们将研究初始阿片类药物 临床相关患者结局的处方，以便更好地了解如何限制阿片类药物 通过立法的处方可能会影响急诊科的急性疼痛患者， 条件 根据我们的研究结果，我们将提出基于证据的建议，以加强现有的阿片类药物 立法，以及制定和执行R 01资助的全面实施试验，重点不是 不仅要改变个体提供者的行为，还要改变群体文化和社会规范 影响阿片类药物处方行为。 !

PROJECT SUMMARY The objective of this NIDA K08 career development proposal is to gain experience and training to become an independent investigator focused on the development of evidence-based practices to prevent and treat substance use disorders in the emergency department. Opioid use disorders, including overdose and addiction, have become epidemic in the United States. While research has largely focused on long-term opioid prescribing in the outpatient setting, emergency department opioid prescribing for acute painful conditions as a portal for future adverse patient outcomes remains poorly defined. State governments, including the Commonwealth of Massachusetts, have reacted to the opioid crisis in part by crafting legislation to broadly limit legal opioid prescriptions. However, opioid medications remain an important treatment option for some acute painful conditions, and evidence based guidance on appropriate prescribing is lacking, in part because the factors that impact providers opioid prescribing behaviors and subsequent patient associated adverse outcomes remains unknown. Understanding the underlying factors that influence opioid prescribing behaviors and future patient outcomes, including state legislation, peer behaviors, hospital attitudes, and local culture, is a critical step in developing integrated, evidence-based recommendations that focus on transforming the culture surrounding safe opioid prescribing practices. Using the theory of planned behavior as a framework, the goals of this K08 grant application are to understand opioid prescribing behaviors and adverse patient outcomes through the following aims: First, we will assess the influence of state legislation, specifically the 2016 Massachusetts (MA) Opioid Law, on the formation of hospital-based regulations and providers' perceived attitudes towards opioid prescribing through qualitative interviews with local physician leaders in MA. Second, using comprehensive claims data, we will evaluate the impact of the 2016 MA Opioid Law on statewide opioid prescribing, using a neighboring state without opioid legislation as a natural control. Finally, we will examine the association of an initial opioid prescription on clinically relevant patient outcomes in order to better understand how restricting opioid prescriptions through legislation may impact emergency department patients presenting with an acute painful condition. From our results, we will create evidence-based recommendations to enhance existing opioid legislation, as well as develop and execute R01 funded comprehensive implementation trials that focus not only on changing behaviors of individual providers, but also transforming the group culture and social norms that influence opioid prescribing behaviors. !