Assessing the Safety and Effectiveness of Opioid Tapering in Large Health Systems

点击翻译按钮获取中文摘要

PROJECT ABSTRACT The United States is confronting two concurrent public health emergencies of opioid overdoses and the coronavirus disease 2019 (COVID-19). The COVID-19 pandemic may contribute to increases in overdose through widespread disruptions of health services, which include services specific to patients with chronic opioid exposure, either prescribed or non-prescribed. Changes to care delivery implemented in health systems including suspension of non-critical services and clinic closures, along with public health measures such as social distancing and quarantine, can create barriers to timely care. Disruptions to care, such as opioid dose variability and discontinuation, may lead to adverse health outcomes, including opioid overdose. These impacts of the pandemic may be unevenly experienced across subpopulations, with potential to reinforce and exacerbate health disparities. The overall goal of this project is to conduct a longitudinal cohort study to examine potential disparate impacts on health and health services in large health systems. Our specific aims: (1) In patients prescribed long-term opioid therapy (LTOT), characterize changes in opioid analgesic and naloxone prescribing patterns, opioid dose variability and discontinuation, primary care utilization, and opioid overdose before and during the COVID-19 pandemic and COVID-19 testing by race/ethnicity and gender; and (2) In patients with opioid use disorder (OUD), characterize changes in buprenorphine treatment for OUD and naloxone prescribing patterns, addiction treatment utilization, and opioid overdose before and during the COVID-19 pandemic and COVID-19 testing by race/ethnicity and gender. We will leverage a data system developed in the parent grant (Pathways to Opioid Safety Datalink [POSD]) that contains data on more than 2.5 million people in Colorado and Wisconsin. We will examine changes in health services in cohorts of patients prescribed chronic opioid therapy and with an opioid use disorder (OUD) before and during the COVID-19 pandemic from 2019 to 2020. Our findings will inform strategies to address under-utilization of appropriate healthcare during the COVID-19 pandemic among vulnerable populations, including improved delivery of care, expanded access to harm reduction measures, and targeted COVID-19 testing.