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

项目总结 NIDA K08职业发展计划的目标是获得经验和培训，以 成为一名独立调查员，专注于发展循证做法，以预防和 在急诊科治疗药物使用障碍。阿片类药物使用障碍，包括过量和 上瘾，在美国已经变得流行起来。虽然研究主要集中在长期阿片类药物上 在门诊部开处方，急诊科开阿片类药物治疗急性疼痛 未来不良患者结局的门户仍未得到明确定义。 包括马萨诸塞州联邦在内的州政府在#年对阿片类药物危机做出了反应。 部分方法是制定立法，广泛限制合法的阿片类药物处方。然而，阿片类药物仍然是一种 对于一些急性疼痛情况，重要的治疗选择，以及基于证据的适当指导 缺乏处方，部分原因是影响提供者阿片类药物处方行为的因素和 后续与患者相关的不良后果尚不清楚。了解潜在的 影响阿片类药物处方行为和未来患者结果的因素，包括国家立法、同行 行为、医院态度和当地文化是发展综合的、循证的关键一步 侧重于改变围绕安全阿片类药物处方做法的文化的建议。 以计划行为理论为框架，这项K08拨款申请的目标是 通过以下目标了解阿片类药物处方行为和不良患者结果：第一，我们 将评估州立法，特别是2016年马萨诸塞州(MA)阿片法对 以医院为基础的法规的形成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的定性访谈。第二，使用全面的索赔数据，我们将 评估2016年MA阿片类药物法对使用邻近州的全州阿片类药物处方的影响 没有阿片类药物立法作为自然对照。最后，我们将研究最初的阿片类药物与 关于临床相关患者结局的处方，以便更好地了解限制阿片类药物 通过立法开出的处方可能会影响急诊科出现急性疼痛的患者 条件。 根据我们的结果，我们将创建基于证据的建议，以加强现有的阿片类药物 立法，以及开发和执行R01资助的全面实施试验，这些试验的重点不是 不仅在于改变个体提供者的行为，还在于改变群体文化和社会规范 影响阿片类药物处方行为的药物。 好了！

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. !