Characterizing non-medical prescription opioid use and pain in people living with HIV

 描述（由申请人提供）：处方阿片类药物（PO）使用，包括非医疗PO（NMPO）使用，在美国已变得非常普遍。这对艾滋病毒感染者（PLHIV）有重大影响，对他们来说，慢性疼痛（通常未被诊断或未完全缓解）和物质使用是常见的。据报道，一般人群中使用NMPO和大麻进行疼痛症状的自我管理，一些研究发现更高的疼痛干扰和NMPO使用之间存在关联。然而，NMPO在PLHIV中使用的严重程度还没有得到很好的描述。据报道，它比一般人群高2-3倍，但这些少数研究依赖于过时的数据或不具有代表性。此外，尽管与一般人群相比，这些疾病的患病率较高，但关于慢性疼痛与PLHIV患者使用药物（特别是NMPO使用）之间关系的研究很少。本提案的目的是描述NMPO使用PLHIV的特点，并探讨NMPO使用，慢性疼痛和大麻使用在美国东南部的一个大型HIV诊所的交叉点，HIV和PO使用的联合流行病是尖锐的。我们提出了一个横断面调查的500 PLHIV接受护理在范德比尔特综合艾滋病护理诊所（VCCC），以实现以下目标：目的1 -NMPO使用的特点在我们的广义艾滋病患者人群，并评估其与不受控制或缓解不足的慢性疼痛。目的2 -确定大麻使用，不受控制或不充分缓解慢性疼痛和NMPO使用之间的关联。将从多个来源收集数据，包括疼痛和药物使用的综合调查、尿液药物筛查和来自电子病历的临床数据。将详细描述NMPO使用情况，包括处方阿片类药物的来源和现有或历史，并与非使用者进行进一步比较。多变量逻辑回归分析将探索目标1和2，同时控制重要的混杂因素，包括社会人口统计学、抑郁和焦虑。我们假设，较高水平的疼痛缓解不充分将与较高的NMPO（目标1）和大麻（目标2）的使用。我们假设大麻-NMPO使用关联（目标2）将根据慢性疼痛状态而有所不同，反映了报告疼痛的患者对疼痛的自我管理，以及未报告疼痛的患者对娱乐性多种物质的使用。在高物质使用的人群中，拟议的研究通过不受控制或不充分缓解疼痛的透镜探索NMPO使用，这可能代表与其他非法物质不同的行为 使用.研究结果将为如何更好地在临床上管理疼痛提供见解，同时避免PO使用的已知风险，如误用，依赖和过量。虽然需要对艾滋病毒感染者中这个未充分研究的问题进行大量研究，但拟议的研究为这项重要工作奠定了基础。

 DESCRIPTION (provided by applicant): Prescription opioid (PO) use, including non-medical PO (NMPO) use, has become alarmingly common in the US. This has major implications for people living with HIV (PLHIV), for whom chronic pain, which is often undiagnosed or incompletely relieved, and substance use are common. Self-management of pain symptoms with NMPOs as well as marijuana has been reported in the general population, and some studies found associations between higher pain interference and NMPO use. The severity of NMPO use among PLHIV, however, is not well described. It has been reported to be 2-3 times higher than in the general population, but these few studies relied on outdated data or non-representative. Furthermore there is a paucity of research on the relationship between chronic pain and substance use (NMPO use, specifically) in PLHIV despite the well-documented, higher prevalence of these conditions compared to the general population. The objective of this proposal is to characterize NMPO use among PLHIV and explore the intersection of NMPO use, chronic pain, and marijuana use in a large HIV clinic in the Southeastern US where the joint epidemics of HIV and PO use are acutely felt. We propose a cross-sectional survey of 500 PLHIV receiving care at the Vanderbilt Comprehensive HIV Care Clinic (VCCC) to achieve the following aims: Aim 1 - To characterize NMPO use in our generalized HIV patient population and assess its association with uncontrolled or insufficiently relieved chronic pain. Aim 2 - To determine the associations between marijuana use, uncontrolled or insufficiently relieved chronic pain, and NMPO use. Data will be collected from multiple sources including a comprehensive survey on pain and substance use, urine drug screen, and clinical data from electronic medical records. NMPO use will be described in detail, including source and existing or history of prescribed opioids, and further compared to non-users. Multivariable logistic regression analysis will explore Aims 1 and 2 while controlling for important confounders including socio-demographics, depression, and anxiety. We hypothesize that higher levels of insufficiently relieved pain will be associated with higher NMPO (Aim 1) and marijuana (Aim 2) use. We hypothesize that the marijuana-NMPO use association (Aim 2) will differ depending on chronic pain status, reflecting self-management of pain among those reporting pain, and recreational, polysubstance use among those not reporting pain. In a population with high substance use, the proposed study explores NMPO use through the lens of uncontrolled or insufficiently relieved pain, which may represent a different behavior from other illicit substance use. Findings will provide insight into how to better manage pain clinically, while avoiding known risks of PO use such as misuse, dependence, and overdose. While much research will need to be done on this understudied issue among PLHIV, the proposed study lays the foundation for this important work.