Mentoring Junior Investigators to Tackle the Opioid Epidemic

摘要 我的总体目标是推进阻止阿片类药物流行所需的证据，并将证据转化为 转化为现实世界的实施和有效的公共卫生政策。美国目前的阿片类药物流行病是 由于处方阿片类药物（PO）广泛用于慢性疼痛。作为回应， 政策越来越多地促进使用阿片类药物风险缓解策略，如PO逐渐减少（减少剂量或 停止PO）。然而，阿片类药物风险缓解策略的采用速度超过了证据， 例如，PO逐渐减少的结果和在现实世界HIV中实施PO逐渐减少的最佳策略， 初级保健设置是未知的。PO减量可能对HIV控制产生特别严重的影响，如果 逐渐减少导致患者脱离艾滋病毒护理或用非法或注射阿片类药物取代PO;但风险 尚未量化，与这些结果相关的因素也没有描述。鉴于 总体上缺乏关于PO风险缓解战略及其实施的证据， 为了应对这一流行病，必须扩大临床医生调查人员的能力， HIV+和HIV-个体中PO使用的定向研究。我是一名治疗慢性疼痛和阿片类药物的医生 使用障碍，一名研究人员专注于明智的PO处方超过十年，和一名教育工作者， 强大的辅导记录和特殊的机构资源，以支持学员。K24职业生涯中期 研究者奖将有助于扩大临床研究人员在该领域的能力：1）提供杰出的 指导初级研究人员专注于PO在慢性疼痛中的使用，2）扩大我的研究， 实施科学方法，以优化将证据转化为实践，以及3）推进我的 在将关于PO使用的证据转化为指南和卫生政策方面发挥领导作用。我坚固的 现有的研究项目侧重于HIV+和HIV-慢性感染患者的PO风险缓解实践。 疼痛，沿着与优秀的顾问和机构资源，将提供一个平台，指导和 拓展我的技能使用我现有的研究队列和新的主要数据收集，包括定性 访谈和离散选择实验，我们提出了以下新的研究目标：1）检查 HIV+和HIV-慢性疼痛患者PO逐渐减少的阳性和阴性结局，以及2） 确定HIV+和HIV-慢性感染患者对不同PO减量策略的偏好 疼痛和高风险PO使用。所有拟议的研究将与学员进行，并将提供充足的 学员在不同的研究方法，负责任的研究行为发展的机会，以及 准备手稿和赠款申请。研究结果将为未来的干预措施提供信息， PO逐渐变细的指南。总体而言，拟议的指导、职业发展和研究计划将 扩大应对阿片类药物流行的能力。

ABSTRACT My overall goal is to advance the evidence needed to stem the opioid epidemic, and to translate the evidence into real-world implementation and effective public health policy. The current opioid epidemic in the US was driven by widespread use of prescription opioids (POs) for chronic pain. In response, guidelines and health policies increasingly promote use of opioid risk mitigation strategies such as PO tapering (reducing the dose or discontinuing POs). However, adoption of opioid risk mitigation strategies is outpacing the evidence, for example, outcomes of PO tapering and optimal strategies for implementing PO tapering in real-world HIV and primary care settings are unknown. PO tapering can have particularly serious implications for HIV control, if tapering causes patients to fall out of HIV care or replace POs with illicit or injected opioid use; but the risks have not been quantified and factors associated with these outcomes have not been described. Given the overall lack of evidence about PO risk mitigation strategies and their implementation and the urgency of addressing the epidemic, it is imperative to expand the capacity of clinician-investigators conducting patient- oriented research on PO use in HIV+ and HIV- individuals. I am a physician who treats chronic pain and opioid use disorder, an investigator focused on judicious PO prescribing for over a decade, and an educator with a strong mentoring track record and exceptional institutional resources to support mentees. This K24 mid-career investigator award will help to expand capacity of clinician investigators in the field by: 1) providing outstanding mentorship to junior investigators focused on PO use in chronic pain, 2) expanding my research in implementation science methodologies to optimize translating evidence into practice, and 3) advancing my development as a leader in translating evidence about PO use into guidelines and health policy. My strong existing research program focused on PO risk mitigation practices for HIV+ and HIV- patients with chronic pain, along with exceptional advisors and institutional resources, will provide a platform for mentoring and expanding my skills. Using my existing study cohorts and new primary data collection including qualitative interviews and a discrete choice experiment, we propose the following new research aims: 1) to examine the positive and negative outcomes of PO tapering among HIV+ and HIV- patients with chronic pain, and 2) to identify patient preferences for different PO tapering strategies among HIV+ and HIV- patients with chronic pain and high-risk PO use. All proposed research will be conducted with mentees and will provide ample opportunities for mentee development in diverse research methods, responsible conduct of research, and preparing manuscripts and grant applications. Findings from the research will inform future interventions and guidelines for PO tapering. Overall, the proposed plans for mentoring, career development, and research will expand capacity to address the opioid epidemic.