Co-Use of Opioid Medications and Alcohol Prevention Study (COAPS)

公共卫生摘要 众所周知，酒精和阿片类药物的共同使用是一种严重的健康/安全危害-但仍然存在 尽管有这些负面影响。由于同行评审文献中的信息有限，大型- 量表系统和临床研究表明，24-38%的酒精使用障碍患者也有 阿片类药物成瘾，在寻求酒精治疗的人中，过去30天阿片类药物滥用的比例 高达68%。我们的研究表明，在接受阿片类药物治疗的社区药房患者中， 对于疼痛管理，大约20-30%的人同时使用酒精。社区药房是一个高度 有价值但未充分利用的资源和环境，用于识别和干预，以解决美国阿片类药物表- demic。我们建议调整，手动化，并测试可接受性，可行性和初步疗效的一个 酒精靶向短期干预-药物治疗管理（ABI-MTM）社区干预 药房患者ABI-MTM将是一种以药房为基础的药物管理干预措施， 筛查、短暂干预和转诊治疗，目标是：（1）阿片类药物治疗期间消除酒精使用 治疗或（2）非阿片类疼痛管理替代品（与处方者协商）。我们会进行 在3个社区药房进行的小规模试验，我们将随机分配重度饮酒患者 和非重度酒精使用（1比1的比例）ABI-MTM（n=20）或标准药物咨询（SMC， n=20）。结果将证明干预的可接受性、可行性和初步疗效。本研究还将 努力确定药房系统和实践层面的障碍和促进因素，以普及酒精筛查， 阿片类药物接受者的干预。我们将制定一个混合方法评估指南采访药房 技术人员（N=20）、药剂师（N=20）和企业领导（N=20）。访谈将评估对- 病房筛查/干预，内部组织挑战，以及与ABI-MTM实施相关的流程， 进行大规模的研究和实践。总之，这项研究的结果将提供关键的见解，发现- 国家数据和策略，执行一个有力的试验和可能的未来系统/实践水平的实施。

PUBLIC HEALTH ABSTRACT Co-use of alcohol and opioid medications is known to be a serious health/safety hazard—yet persists despite these negative ramifications. With limited information available within peer-reviewed literature, large- scale system and clinical research have demonstrated 24-38% of those with alcohol use disorders also have an opioid addiction, with rates of past 30-day opioid medication misuse among those seeking alcohol treatment as high as 68%. Our research has shown that among community pharmacy patients receiving opioid medications for pain management, approximately 20-30% are engaged in co-use of alcohol. Community pharmacy is a highly valuable but underutilized resource and setting for identification and intervention to address the US opioid epi- demic. We propose to adapt, manualize, and test the acceptability, feasibility, and preliminary efficacy of an Alcohol-targeted Brief Intervention-Medication Therapy Management (ABI-MTM) intervention with community pharmacy patients. ABI-MTM will be a pharmacy-based medication management intervention, combined with Screening, Brief Intervention, and Referral to treatment that will target: (1) alcohol use elimination during opioid treatment OR (2) non-opioid pain management substitution (in consultation with the prescriber). We will conduct a small-scale trial in 3 community pharmacy locations wherein we will randomize patients with heavy alcohol use and with non-heavy alcohol use (1-to-1 ratio) to ABI-MTM (n=20) or standard medication counseling (SMC, n=20). Results will demonstrate intervention acceptability, feasibility, and preliminary efficacy. This study will also work to identify pharmacy system and practice-level barriers and facilitators for universal alcohol screening and intervention among opioid recipients. We will develop a mixed methods assessment guide to interview pharmacy technicians (N=20), pharmacists (N=20), and corporate leaders (N=20). Interviews will assess perceptions to- wards screening/intervention, internal organizational challenges, and processes related to ABI-MTM implemen- tation for large-scale research and practice. Altogether, results of this study will provide critical insights, founda- tional data, and strategies for executing a powered trial and possible future system/practice-level implementation.