Weighting Longitudinal Data to Access Opioid Analgesia Tapering Outcomes among Patients with Co-occurring Chronic Pain and Substance Use Disorder

项目总结/摘要 2016年，疾病控制中心（CDC）发布了建议非药物治疗的指南。 治疗慢性疼痛超过使用阿片类镇痛药，以应对过量死亡的增加，并基于 研究显示，非阿片类药物和多学科方法治疗疼痛有助于功能和疼痛严重程度 改进. CDC指南还建议使用药物的慢性疼痛患者逐渐减少阿片类药物 阿片类药物使用障碍（SUD）和过渡到阿片类药物使用障碍（MOUD）的患者合并阿片类药物 使用障碍（OUD）。虽然阿片类药物逐渐减少已被广泛实施，但很少有研究评估过渡到 MOUD或多学科药物特别用于慢性疼痛和并发SUD的患者。一 这种知识有限的主要原因是慢性疼痛和并发SUD的人群通常 在任何给定的医疗保健机构或系统中相对较小，并且感兴趣的结果可能发生在较低的总体 号码因此，需要一个大型数据库来对与下列因素相关的结果进行多因素研究： 阿片类药物逐渐减少的不同方法，特别是在评估较小的 人口群体。为了解决这一关键差距，我们的目标是为Cerner Real-World创建权重。 数据库，其中包括电子健康记录（EHR）数据，来自超过1亿独特的美国患者在600 参与的医院和诊所。我们的假设是，加权数据库将显着提高其 为了纵向评估阿片类药物逐渐减少、多学科 药物、MOUD和合并SUD的慢性疼痛患者的结局。我们的目标是利用美国 医院协会和美国人口普查数据来创建权重，按医院特征分层并进行调整 按人口统计变量，用于分析Cerner数据库（目标1）;验证目标1中的加权方案 通过比较Cerner数据库的加权估计值和一个成熟的人口估计值（ 全国住院患者样本），用于慢性疼痛、SUD和药物过量诊断以及相关多学科疼痛 2000-2025年的干预措施（目标2）;在慢性疼痛和并发OUD患者中，检查 逐渐减少阿片类镇痛药和过渡到MOUD如何影响过量，自杀和其他风险 住院治疗，并评估性别和种族/民族如何在这些关系中作为效应调节因子（Aim 3）;在慢性疼痛和并发SUD的患者中，检查逐渐减少阿片类镇痛药， 使用多学科疼痛治疗会影响药物过量、自杀和其他住院治疗的风险，并评估 性别和种族/民族如何在这些关系中起作用（目标4）。该项目将创建一个 具有经验证的权重的国家数据库，可对阿片类药物减量方法进行严格审查 在慢性疼痛和共同发生的SUD患者中，这将随后提高对如何 多学科疼痛治疗和MOUD影响风险，同时考虑到 人口亚群

Project Summary/Abstract In 2016, the Centers for Disease Control (CDC) released guidelines recommending non-pharmacologic treatment for chronic pain over use of opioid analgesia in response to rising overdose deaths and based on studies showing nonopioid and multidisciplinary approaches to pain contribute to functional and pain severity improvements. CDC guidelines also recommended opioid tapering for chronic pain patients with substance use disorder (SUD) and transition to medications for opioid use disorder (MOUD) for patients with co-occurring opioid use disorder (OUD). While opioid tapering has been widely implemented, few studies assess transitions to MOUD or multidisciplinary medicine use specifically among patients with chronic pain and co-occurring SUD. A primary reason for this limited knowledge is the population with chronic pain and co-occurring SUD is often relatively small in any given healthcare facility or system, and outcomes of interest may occur in low total numbers. Thus, a large database is required to conduct multifactorial research on outcomes associated with different approaches to opioid tapering, especially when evaluating whether trends hold among smaller demographic groups. To address this critical gap, our goal is to create weights for the Cerner Real-World© database, which includes electronic health records (EHR) data from over 100 million unique U.S. patients at 600 participating hospitals and clinics. Our hypothesis is that weighting the database will significantly enhance its representativeness in order to longitudinally assess the relationship between opioid tapering, multidisciplinary medicine, MOUD, and outcomes for chronic pain patients with co-occurring SUD. Our aims are to use American Hospital Association and U.S. Census data to create weights, stratified by hospital characteristics and adjusted by demographic variables, for analyzing the Cerner database (Aim 1); validate the weighting scheme in Aim 1 by comparing weighted estimates from the Cerner database to estimates from a well-established population (the Nationwide Inpatient Sample) for chronic pain, SUD, and overdose diagnoses and relevant multidisciplinary pain interventions for the years 2000-2025 (Aim 2); among patients with chronic pain and co-occurring OUD, examine how tapering opioid analgesics and transitioning to MOUD affects risk for overdose, suicide, and other hospitalizations, and assess how sex and race/ethnicity operate as effect modifiers in these relationships (Aim 3); and among patients with chronic pain and co-occurring SUD, examine how tapering opioid analgesics while using multidisciplinary pain treatment affects risk for overdose, suicide, and other hospitalizations, and assess how sex and race/ethnicity operate as effect modifiers in these relationships (Aim 4). This project will create a national database with validated weighting that will enable rigorous examination of opioid tapering approaches among patients with chronic pain and co-occurring SUD, which will subsequently improve knowledge of how multidisciplinary pain treatment and MOUD affect risks, while considering tapering-related inequities among demographic subpopulations.