Implicit Cognition Assessments for Risk of Prescription Opioid Abuse

描述（由申请人提供）：这项SBIR I期申请提议开发MedicaSafe的隐性处方滥用认知工具包（IMPACT），这是一套基于技术的认知评估工具，可显着提高医生检测阿片类药物滥用和滥用阿片类药物治疗患者的迹象的能力。MedicaSafe的IMPACT将包括处方阿片类药物特定版本的两种最有效的内隐测量-内隐关联测试（IAT）和药物Stroop任务。IMPACT评估将是简短的、计算机化的措施，将告知医生影响药物使用行为的患者的特定的、无意识的阿片类药物相关认知，显著改善提供者目前可用的措施，并改善阿片类药物治疗患者的整体临床护理。处方阿片类药物治疗慢性非癌性疼痛的使用在过去二十年中以惊人的速度增加。对处方阿片类药物误用和滥用的担忧促使美国食品和药物管理局（FDA）采取新行动，实施安全使用措施，如风险评估和缓解战略（REMS）。尽管对处方类阿片滥用流行病的担忧持续增加，但每年有1亿多美国人患有慢性疼痛，对身心健康造成严重损害。为了应对这一双重公共卫生挑战，该领域的主要决策者现在建议采取一种平衡的方法，强调明智的阿片类药物处方和持续的风险监测。需要在评估战略方面取得新的进展，以便采取平衡的办法，在减轻处方类阿片的误用和滥用的同时，最好地解决患者的痛苦。神经科学的最新发现使研究人员能够深入了解药物使用者的无意识想法和动机。本第一阶段建议将这些进展扩展到处方阿片类药物使用的研究，以解决处方阿片类药物误用和滥用的公共卫生挑战。第一阶段将涉及建议的处方阿片类药物滥用隐性措施的实证开发和验证。由内隐测量方法、内隐认知和成瘾方面的关键意见领袖组成的专家小组将协助MedicaSafe员工实现这一目标。随着隐性评估的发展，一项验证性研究将在一家疼痛管理诊所进行，评估MedicaSafe隐性评估的能力，以增加目前最有效的阿片类药物滥用的显性筛查和持续监测。第一阶段的重点将是建立隐性评估的有效性，以及它们在检测阿片类药物滥用方面的临床应用，这些评估超出了医生目前可用的评估策略。

DESCRIPTION (provided by applicant): This SBIR Phase I application proposes development of MedicaSafe's Implicit Prescription Abuse Cognitive Toolkit (IMPACT), a technology-enabled suite of cognitive assessment tools to significantly add to physicians' ability to detect signs of opioid misuse and abuse in patients on opioid therapies. MedicaSafe's IMPACT will comprise prescription opioid-specific versions of two of the most validated implicit measures -- the Implici Association Test (IAT) and Drug Stroop Task. IMPACT assessments will be brief, computerized measures that will inform physicians of the specific, unconscious opioid-related cognitions of their patients that affect substance use behaviors, significantly improving upon the measures currently available to providers and improving clinical care overall for patients on opioid therapy The use of prescription opioids to treat chronic non-cancer pain has increased at a staggering pace over the last two decades. Concern over the misuse and abuse of prescription opioids has led to new actions by the U.S. Food and Drug Administration (FDA) to implement safe-use measures, such as Risk Evaluation and Mitigation Strategies (REMS). Although concern over the epidemic of prescription opioid abuse continues to increase, more than 100 million Americans suffer from chronic pain each year, causing significant impairment in physical and emotional health. To address this dual public health challenge, key decision makers in the field now recommend a balanced approach that stresses judicious opioid prescribing and ongoing risk monitoring. New advancements in assessment strategies are needed to enable a balanced approach that will best address patient suffering while mitigating the misuse and abuse of prescription opioids. Recent findings in neuroscience have allowed researchers to gain insight into the unconscious thoughts and motivations of substance users. This Phase I proposes to extend these advancements to the study of prescription opioid use in order to address the public health challenge of prescription opioid misuse and abuse. Phase I will involve the empirical development and validation of the proposed implicit measures of prescription opioid misuse. An expert panel of key opinion leaders in implicit measure methodology, implicit cognition, and addiction will assist MedicaSafe staff in this goal. Upon development of the implicit assessments, a validation study evaluating the ability of MedicaSafe's implicit assessments to add to the current most validated explicit screeners and ongoing monitors of opioid misuse will be conducted at a pain management clinic. The focus of this Phase I will be to establish the implicit assessments' validity as well as their clinical utility in detecting opioid misuse above ad beyond the current assessment strategies available to physicians.