Pain and Misuse of Prescription Opioids in a Community-Based HIV-Infected Cohort

描述（由申请人提供）：本研究的长期目标是改善疼痛控制，减少治疗不足的疼痛、阿片类镇痛异常行为和成瘾高危人群的异常行为和阿片类镇痛成瘾。我们建议进行一项前瞻性队列研究，检查社区贫困艾滋病毒感染成人队列中阿片类镇痛药的使用和滥用。我们提出以下具体目标：目标1：确定社区贫困HIV感染者中疼痛的患病率、特征和可变性，这些人有或没有共存的物质使用障碍。目的2：确定疼痛的控制是否由疼痛治疗地点（即，在初级保健机构内或外）或疼痛合同的使用来预测。目的3：确定异常阿片类镇痛行为的预测因素，包括疼痛治疗地点（即，在初级保健关系内或外）、给药方案（即长效与短效）和疼痛合约的使用。我们将共同招募REACH队列的成员，这是一个hiv感染成人的纵向队列，他们有很高的非法药物使用率和精神健康问题，并随访2年。除了利用在参与者身上收集的数据作为REACH的一部分（健康状况、精神健康状况和住房状况），我们还将使用四个额外的信息来源：季度结构化访谈（关于疼痛和镇痛药的使用、滥用和物质使用）、尿液毒理学测试、药房记录审查和提供者访谈。利用这些数据来源，我们将研究物质使用和依赖、疼痛、处方镇痛药（包括阿片类药物）的使用、用于控制疼痛的卫生服务利用以及异常处方阿片类药物行为的比率。通过研究控制疼痛的不同策略与疼痛和异常行为之间的关系，该研究将为高风险人群安全治疗疼痛的最佳方法提供指导。本研究将阐明高危人群疼痛的社区实践，并将为如何减少阿片类镇痛异常行为和成瘾提供指导。随着阿片类镇痛药使用的增加，了解与滥用相关的因素至关重要。这项研究的结果将为未来的实践提供信息，以提高我们对滥用风险因素的理解，并为减少滥用和成瘾提供指导。

DESCRIPTION (provided by applicant): The long-term goal of this research is to improve pain control and reduce aberrant behaviors and opioid analgesic addiction in persons at high risk for undertreated pain, opioid analgesic aberrant behaviors, and addiction. We propose to conduct a prospective cohort study examining the use and misuse of opioid analgesics in a community-based cohort of indigent HIV-infected adults. We propose the following specific aims: Aim 1: To determine the prevalence, characteristics and variability of pain in a community-based cohort of indigent persons with HIV infection who do and do not have a coexisting substance use disorder. Aim 2: To determine whether control of pain is predicted by the site of pain treatment (i.e., within or outside of a primary care setting) or the use of pain contracts. Aim 3: To determine predictors of aberrant opioid analgesic behaviors including the site of pain treatment (i.e., within or outside of a primary care relationship), the dosing regimen (i.e. long-acting versus short-acting), and the use of pain contracts. We will co-enroll members of the REACH cohort, a longitudinal cohort of HIV-infected adults who have high rates of illicit substance use and mental health problems, and follow them for 2 years. In addition to utilizing data collected on participants as part of REACH (health status, mental health status, and housing status), we will use four additional sources of information: quarterly structured interviews (about pain and analgesic use, misuse and substance use), urine toxicology tests, pharmacy record review, and provider interviews. Using these data sources, we will examine substance use and dependence, pain, use of prescription analgesics (including opioids), health service utilization for pain control, and rates of aberrant prescription opioid behavior. By examining the association between different strategies for controlling pain with pain and aberrant behaviors, the study will provide guidance as to the best way to treat pain safely in high-risk persons. This research will elucidate community practices regarding pain in high-risk populations and will provide guidance in how to reduce opioid analgesic aberrant behaviors and addiction. As opioid analgesic use increases, understanding the factors associated with misuse is critical. The results of this research will inform future practice to improve our understanding of risk factors for misuse and provide guidance for reducing misuse and addiction.