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，减少疼痛治疗不足、阿片类镇痛剂异常行为和成瘾高危人群的异常行为和阿片类镇痛剂成瘾。我们建议进行一项前瞻性队列研究，检查阿片类镇痛药在贫困的艾滋病毒感染成人社区队列中的使用和滥用情况。我们提出了以下具体目标：目标1：确定疼痛的患病率，特点和变异性在一个以社区为基础的队列贫困的艾滋病毒感染者有和没有共存的物质使用障碍。目的2：确定疼痛的控制是否通过疼痛治疗的部位（即，在初级保健环境之内或之外）或使用疼痛合同。目的3：确定异常阿片类镇痛行为的预测因子，包括疼痛治疗部位（即，在初级护理关系之内或之外）、给药方案（即长效与短效）以及疼痛合同的使用。我们将共同招募REACH队列的成员，这是一个纵向队列，由HIV感染的成年人组成，他们有很高的非法药物使用率和心理健康问题，并对他们进行为期2年的随访。除了利用作为REACH（健康状况，心理健康状况和住房状况）的一部分收集的参与者数据外，我们还将使用四个额外的信息来源：季度结构化访谈（关于疼痛和镇痛药使用，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。使用这些数据源，我们将检查物质使用和依赖，疼痛，处方镇痛药（包括阿片类药物）的使用，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发生率。通过检查控制疼痛的不同策略与疼痛和异常行为之间的关联，该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有关疼痛的社区实践，并将为如何减少阿片类镇痛药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.