Role of disability and pain in opioid overdose: mechanism and risk mitigation

在阿片类药物过量的推动下，美国的药物过量死亡人数呈指数级增加。同时， 美国的监测研究记录了中年成年人中残疾患病率的增加。人民 有残疾的人有较高的阿片使用障碍(OUD)率，但不太可能接受治疗 它，使他们面临更高的阿片类药物过量风险。尽管存在这些既定风险，但残疾人 在阿片类药物危机的背景下，仍然是一个未得到充分研究的群体。很大程度上是因为 残疾人可能是由于慢性疼痛所致。许多肢体残疾的人都会经历慢性疼痛 这要么会导致被称为“高冲击性慢性疼痛”的残疾，要么会同时发生。慢性疼痛是 经常使用处方阿片类药物进行管理，有时通过危险的处方做法。除了慢性 痛苦，经历抑郁或失去经济机会的途径及其伴随的压力源 可能会将身体残疾与过量服药风险联系起来。阿片类药物处方治疗慢性疼痛与增加 阿片类药物过量的风险，但由于身体残疾而产生的任何此类风险，与慢性 疼痛，还没有估计-也没有与同时发生的身体残疾和慢性疾病相关的风险 疼痛。此外，残疾和慢性疼痛影响服药过量风险的机制有 未知。物质使用障碍(SODS)的推荐治疗的可用性，包括OUD，和 慢性疼痛可能会影响我们打算研究的关系、机制和相关的差异， 但在不同地区是高度可变的。本项目的目标是：目标1)评估独特的和 身体残疾和慢性疼痛状况对阿片类药物过量风险的联合贡献以及 哪些疼痛管理实践调节了这些关系；目标2)开发新的统计方法来 将中介效应从一种状态传输到另一种状态，并在目标3)中应用这些方法来识别SUD和 疼痛管理治疗指标，如果得到改善，可能会降低与以下两项相关的总体过量风险 身体残疾和慢性疼痛以及按种族/族裔-性别分组的服药过量风险差异。我们会 利用不同的地理位置进行SUD和疼痛管理治疗并预测其效果 现实的分娩改进将对减少这一弱势群体中的阿片类药物过量产生影响。 这项拟议的研究预计将评估身体残疾增加阿片类药物风险的程度 过量服药，可归因于慢性疼痛和伴随而来的高风险疼痛管理的风险增加的比例- 治疗实践(与非慢性疼痛机制相比)，以及可通过以下方式减轻风险的程度 改善提供适当的慢性疼痛管理和SUD(包括OUD)治疗。这 将使未来的预防战略能够针对人们面临的特殊需求和挑战而量身定做 肢体残疾患者，目标是最终为改善处方做出重大贡献 提供建议的治疗方法，以降低其阿片类药物过量的风险。

Drug overdose deaths in the US have increased exponentially, driven by opioid overdoses. Concurrently, US surveillance studies have documented increased disability prevalence among adults in midlife. People with disabilities have higher rates of opioid use disorder (OUD) but are less likely to receive treatment for it, putting them at higher risk for opioid overdose. Despite these established risks, people with disabilities remain an understudied subpopulation in the context of the opioid crisis. Much of heightened risk among the disabled population may be due to chronic pain. Many people with physical disability experience chronic pain that either drives the disability, termed “high-impact chronic pain”, or that occurs concurrently. Chronic pain is frequently managed with prescription opioids, sometimes via risky prescribing practices. In addition to chronic pain, pathways through depression or through loss of economic opportunity and its accompanying stressors may link physical disability to overdose risk. Opioid prescribing for chronic pain has been linked to increased risk of opioid overdose, but any such risk conferred by having a physical disability, disentangled from chronic pain, has not been estimated—nor has the risk associated with co-occurring physical disability and chronic pain. Moreover, the mechanisms through which disability and chronic pain operate to affect overdose risk are unknown. Availability of recommended treatments for substance use disorders (SUDs), including OUD, and chronic pain may influence the relationships, mechanisms, and the associated disparities we propose to study, but is highly variable across localities. The objectives of this project are: Aim 1) to estimate the unique and joint contributions of physical disability and chronic pain conditions to opioid overdose risk and the extent to which pain management practices mediate these relationships; Aim 2) to develop novel statistical methods to transport mediated effects from one state to another, and to apply those methods in Aim 3) to identify SUD and pain management treatment metrics that, if improved, may reduce both overall overdose risk associated with physical disability and chronic pain and disparities in overdose risk by racial/ethnic-gender subgroup. We will harness geographic variation in the delivery of SUD and pain management treatment and predict the effects that realistic improvements in delivery would have on reducing opioid overdose in this vulnerable population. The proposed research is expected to estimate the extent to which physical disability increases risk of opioid overdose, the proportion of that increased risk attributable to chronic pain and attendant risky pain manage- ment practices (versus non-chronic pain mechanisms), and the extent to which risk may be mitigated by improvements in delivering appropriate chronic pain management and SUD (including OUD) treatment. This will allow for future prevention strategies to be tailored to the particular needs and challenges faced by people with physical disabilities, with the goal of ultimately making a significant contribution to improving prescribing practices and provision of recommended treatments to reduce their risk of opioid overdose.