The Impact of Depression Treatment on Suicide and Overdose Among Patients Receiving Prescription Opioids (Administrative Supplement to R01DA045055)

抑郁症治疗对接受处方阿片类药物的患者自杀和用药过量的影响（R01DA0450​​55 的行政补充）

• 批准号: 10086586
• 负责人: BRADLEY D STEIN
• 金额: $ 21.24万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-15 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10086586
• 关键词: Address; Administrative Supplement; Adult; Affect; Antidepressive Agents; Attention; Behavior; Characteristics; Chronic; Clinical; Complex; County; Data; Data Set; Databases; Depression and Suicide; Dose; Elderly; Emergency department visit; Equilibrium; Feeling suicidal; Funding; Goals; Health Status; Heterogeneity; Improve Access; Incidence; Individual; Inpatients; Intervention; Link; Mediating; Medical; Mental Depression; Mental disorders; Modality; National Institute of Drug Abuse; Opioid; Opioid Analgesics; Outcome; Overdose; Pain; Pain Clinics; Parents; Patient-Focused Outcomes; Patients; Pattern; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacology; Pharmacy facility; Policies; Polypharmacy; Population; Prevalence; Prevention strategy; Public Health; Reporting; Research; Risk; Risk Factors; Role; Self-Injurious Behavior; Suicide; Suicide attempt; Suicide prevention; Time; Vulnerable Populations; Work; adverse outcome; chronic depression; chronic pain; chronic pain patient; comorbid depression; comorbidity; contextual factors; disability; evidence base; high risk; high risk population; improved; mood symptom; opioid epidemic; opioid misuse; opioid overdose; opioid use; overdose prevention; pain symptom; patient subsets; prescription opioid; prescription opioid misuse; primary care setting; response; suicidal behavior; suicidal risk

PROJECT SUMMARY/ABSTRACT Individuals with comorbid pain and depression – particularly those who are treated with prescription opioid analgesics – have a markedly increased risk of suicide, overdose and other opioid-related harms. Given the rising incidence of both suicide and drug overdose in recent years, there is an urgent need to address these intertwined national public health crises by identifying effective strategies to prevent suicide and other opioid- related harms, particularly for vulnerable populations with comorbid pain and depression. Improving access to depression treatment is one strategy that may hold promise: depression is commonly underdiagnosed and undertreated in individuals with pain, despite the fact that effective pharmacologic and non-pharmacologic treatments exist and can improve both pain and mood symptoms. There is a paucity of evidence, however, on the impact of depression treatments on suicide and overdose among patients who are treated with opioid analgesics. The goals of our current NIDA-funded R01, “The Opioid Crisis: The Effects and Unintended Consequences of State Policies on Opioid Analgesic Prescribing,” include examining the relationship between opioid prescribing patterns and adverse patient outcomes. In this administrative supplement we will extend this work to examine outcomes for the understudied yet high-risk subpopulation of patients with chronic pain who may have unrecognized depression, and to assess the role of depression treatment as a potential mediating factor in the relationship between opioid use and opioid-related harms including suicide. Our specific aims are as follows. First, we will examine the relationship between county-level prescribing rates for opioid analgesics and antidepressants, and suicide and overdose rates over time. Second, using individual- level commercial claims data, we will examine the association between pharmacologic and non-pharmacologic treatments for depression, and overdose, intentional self-harm and other opioid-related harms among patients treated with prescription opioids in individual-level analyses. We will also assess for possible heterogeneous effects according to patients' clinical and demographic characteristics, the quality of depression treatment, opioid prescribing patterns and other contextual factors. This research will advance the parent R01's goal of strengthening our response to the public health crises of opioid misuse, overdose and suicide.

项目总结/摘要 患有疼痛和抑郁症的患者-特别是接受处方阿片类药物治疗的患者 镇痛剂-自杀、过量和其他阿片类药物相关危害的风险显著增加。鉴于 近年来，自杀和吸毒过量的发生率不断上升，迫切需要解决这些问题。 通过确定预防自杀和其他阿片类药物的有效策略，交织在一起的国家公共卫生危机- 相关的伤害，特别是对于患有疼痛和抑郁症的弱势群体。改善获得 抑郁症治疗是一种可能有希望的策略：抑郁症通常诊断不足， 尽管有效的药理学和非药理学治疗， 存在治疗并且可以改善疼痛和情绪症状。然而，缺乏证据表明， 抑郁症治疗对接受阿片类药物治疗的患者自杀和过量的影响 止痛药 我们目前的NIDA资助的R 01的目标，“阿片类药物危机： 阿片类镇痛处方的国家政策”，包括检查阿片类药物处方之间的关系， 模式和不良患者结局。在本行政补充中，我们将扩展这项工作，以检查 研究不足但高风险的慢性疼痛患者亚群的结果， 未被认识到的抑郁症，并评估抑郁症治疗作为潜在介导因素的作用 阿片类药物使用与阿片类药物相关危害（包括自杀）之间的关系。 我们的具体目标如下。首先，我们将研究县级处方率之间的关系 阿片类镇痛药和抗抑郁药，以及随着时间的推移自杀和过量服用率。第二，利用个人- 水平的商业索赔数据，我们将检查药理学和非药理学之间的关联 治疗抑郁症，过量，故意自我伤害和患者中的其他阿片类药物相关伤害 在个体水平分析中使用处方阿片类药物治疗。我们还将评估可能的异质性 根据患者的临床和人口统计学特征，抑郁症治疗的质量， 阿片类药物处方模式和其他背景因素。这项研究将推进亲本R 01的目标， 加强我们对阿片类药物滥用、过量和自杀等公共卫生危机的应对。