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

描述(申请人提供)：本研究的长期目标是改善疼痛控制，减少未得到充分治疗的疼痛、阿片类止痛剂异常行为和成瘾的高危人群的异常行为和阿片类止痛剂成瘾。我们建议进行一项前瞻性队列研究，考察贫困HIV感染者社区队列中阿片类止痛药的使用和误用情况。我们提出了以下具体目标：目标1：确定有和没有共存物质使用障碍的贫困艾滋病毒感染者的社区队列中疼痛的患病率、特征和变异性。目的2：确定疼痛控制是通过疼痛治疗的地点(即，在初级保健环境内或之外)还是通过使用疼痛合同来预测的。目的3：确定异常阿片类止痛行为的预测因素，包括疼痛治疗的地点(即，在初级保健关系内或之外)、给药方案(即，长效与短效)，以及疼痛合同的使用。我们将联合招募REACH队列的成员，REACH队列是由非法药物使用和精神健康问题发生率较高的艾滋病毒感染成年人组成的纵向队列，并对他们进行为期两年的跟踪。除了利用收集的参与者数据作为REACH的一部分(健康状况、精神健康状况和住房状况)外，我们还将使用四个额外的信息来源：季度结构化访谈(关于疼痛和止痛药的使用、滥用和物质使用)、尿毒学测试、药房记录审查和提供者访谈。使用这些数据源，我们将检查药物使用和依赖、疼痛、处方镇痛剂(包括阿片类药物)的使用、用于疼痛控制的卫生服务利用率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异常行为之间的关系，这项研究将为高危人群安全治疗疼痛的最佳方法提供指导。这项研究将阐明高危人群中关于疼痛的社区实践，并将为如何减少阿片类止痛药的异常行为和成瘾提供指导。随着阿片类止痛药使用的增加，了解与滥用相关的因素至关重要。本研究的结果将为今后的实践提供指导，以提高我们对误用危险因素的理解，并为减少误用和成瘾提供指导。

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.