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)的使用，包括非医用PO(NMPO)的使用，在美国已经变得令人震惊地普遍。这对艾滋病毒携带者(PLHIV)有重大影响，对他们来说，经常未被诊断或未完全缓解的慢性疼痛和药物使用是常见的。据报道，在普通人群中，使用NMPO和大麻可以自我管理疼痛症状，一些研究发现，更高的疼痛干扰与NMPO的使用之间存在关联。然而，在PLHIV中使用NMPO的严重性并没有得到很好的描述。据报道，这是普通人群的2-3倍，但这些少数研究依赖过时的数据或不具代表性。此外，关于慢性疼痛与PLHIV中物质使用(特别是NMPO使用)之间的关系的研究很少，尽管与普通人群相比，这些疾病的患病率更高，有很好的证明。这项提案的目的是确定PLHIV中NMPO使用的特征，并在美国东南部一家大型艾滋病毒诊所探索NMPO使用、慢性疼痛和大麻使用的交集，在那里，HIV和PO使用的联合流行病受到强烈影响。我们建议对范德比尔特综合艾滋病毒护理诊所(VCCC)接受护理的500名PLHIV患者进行横断面调查，以实现以下目标：目标1-描述NMPO在我们普通HIV患者群体中的使用特征，并评估其与无法控制或未充分缓解的慢性疼痛的关系。目标2-确定大麻使用、慢性疼痛未得到控制或未得到充分缓解与NMPO使用之间的联系。数据将从多种来源收集，包括关于疼痛和药物使用的全面调查、尿液药物筛查和来自电子医疗记录的临床数据。将详细描述NMPO的使用，包括处方阿片类药物的来源和现有或历史，并进一步与非使用者进行比较。多变量Logistic回归分析将探索目标1和目标2，同时控制包括社会人口统计学、抑郁和焦虑在内的重要混杂因素。我们假设，更高水平的未充分缓解的疼痛将与更高的NMPO(目标1)和大麻(目标2)的使用相关。我们假设大麻-NMPO使用关联(目标2)将根据慢性疼痛状况而不同，反映了报告疼痛的人对疼痛的自我管理，以及没有报告疼痛的人娱乐、多种物质的使用。在大量使用药物的人群中，拟议的研究通过未得到控制或未得到充分缓解的疼痛的镜头来探索NMPO的使用，这可能代表了与其他非法物质不同的行为 使用。研究结果将为临床上如何更好地控制疼痛提供洞察力，同时避免已知的PO使用风险，如滥用、依赖和过量用药。虽然需要对艾滋病毒中这一未被充分研究的问题进行大量研究，但拟议的研究为这项重要的工作奠定了基础。

 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 It has been reported to be 2-3 times higher than in the general population, but these few studies relied on outdated data or non-representative.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.