Barriers to and Health Consequences of Non- Pharmacological Chronic Pain Treatment among Patients Tapering Prescription Opioids in a Large Integrated Healthcare System

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PROJECT SUMMARY/ABSTRACT Significance. Long-term opioid therapy (LTOT), previously standard care for chronic pain, led to enormous increases in opioid-related morbidity and mortality. The CDC therefore issued opioid prescribing guidelines in 2016, which was followed by a 70% decline in LTOT in healthcare systems such as the Veterans Health Administration (VHA). Risks of LTOT taper or discontinuation are unclear and there is limited knowledge about the barriers to and clinical effectiveness of the treatments used to supplement LTOT taper, such as non-pharmacological modalities (NPM). Career Development Plan. Dr. Mannes’ training program will include seminars, workshops, coursework, and conferences to develop his skills and expertise in electronic health record (EHR) research methods, longitudinal and causal modeling, and health services research, which are necessary for conducting his proposed research plan and achieving his career goals of becoming an independent health services scientist who conducts large observational studies that will inform the clinical care of people living with chronic pain. Mentorship. A highly accomplished team of mentors who are experts in biostatistics, chronic pain management, and substance use epidemiology, will support Dr. Mannes’ research and training goals. Research Plan. Dr. Mannes will conduct a clinical epidemiological study informed by Andersen’s Model of Health Service Utilization that leverages the size and scope of the VHA EHR (~5,000,000 patients each year) to answer the following questions: 1) What are the health risks of LTOT taper or discontinuation since release of the CDC opioid prescribing guidelines, 2) Are veterans who taper or discontinue LTOT more likely to receive NPM? 3) What are barriers to NPM utilization among patients who taper or discontinue LTOT? and 4) Does NPM use improve health outcomes for patients who taper or discontinue LTOT? To answer these important questions, Dr. Mannes will utilize retrospective longitudinal cohort and cross-sectional study designs using data from 2016-2027. Generalized linear models and Cox-proportional hazard models with Kaplan-Meier survival curves adjusted for sociodemographic, clinical, and healthcare facility characteristics will be used to examine associations between LTOT taper and NPM with care termination, opioid or pain-related emergency department visits or hospitalization, and suicide or overdose mortality. Findings from his study will inform an R01 that will be among the first to use national, EHR data to examine barriers, uptake, and health effects of NPM using the Transformed Medicaid Statistical Information System. Public Health Impact. Increasing access to NPM and identifying clinically effective NPM for people vulnerable to chronic pain are high priority areas for NCCIH. This research will provide policy-relevant information on the consequences of LTOT tapering and NPM at a time when non-opioid therapies for chronic pain are becoming increasingly utilized.