The Impact of Pharmaceutical Industry Messaging on the Opioid Crisis among U.S. Military Veterans

摘要/项目摘要 了解制药业在推动美国目前的阿片类药物危机中的作用是一个 预防未来流行病的基本战略。使用多种形式的文本数据，并创新 数据挖掘和三角测量的方法论，这个项目考察了行业努力的具体影响 将退伍军人作为阿片类药物消费者，并分析新的行业驱动的叙事或剧本， 关于阿片类止痛药的流传。退伍军人有许多弱点，是人群中的一员 受阿片类药物危机和阿片类药物相关危害的影响最严重，包括吸毒过量和艾滋病毒/丙型肝炎病毒 感染。在针对制药公司的诉讼中出现的重要文件证明 退伍军人通过倡导团体和付费账户被视为重要的消费者利基市场 退伍军人对阿片类药物治疗的好处。然而，目前只有一小部分文件是 在法律发现过程中揭示的信息已经被公共卫生研究人员检查过，而很少有 目前已知更广泛的行业议程和支持制药的叙事成为过程 退伍军人特有的健康话语的一部分，推动人们对阿片类药物的态度，并提高非阿片类药物疼痛的门槛 管理层。以确定主题并阐明这些脚本内化的过程 不同的退伍军人群体，这种混合方法的研究将三角测量制药的大型数据集 行业营销和法律文档，包括经验丰富的主题出版物和 慢性疼痛患者。调查结果将转化为对疼痛治疗产生积极影响的可交付成果 政策、实践以及患有慢性疼痛的退伍军人的态度和期望。该科学团队包括 站在揭开烟草行业如何针对军事人员和 退伍军人以及阿片类药物使用和制药业诉讼方面的专家。系统的文本和 本研究中的内容分析代表了制药业变革努力的关键案例研究 规定了政策和流行文化，将是对自然文学的重要贡献 毒品危机的历史和通过实现以下目标对疼痛的临床方法： 目的1：使用文本挖掘技术和烟草研究人员提炼的分析方法来阐明 制药业影响退伍军人(和退伍军人服务组织)认知的运动 阿片类药物治疗，特别是在慢性疼痛管理方面。 目标2：对有疼痛和阿片类药物使用史的退伍军人进行定性访谈，以了解 社会文化意义和认知脚本，阻碍安全、有效和医学上适当的护理。 目标3：基于目标1和目标2的数据合成，进行T0和T1翻译研究以生成 具体的最佳实践、工具和网络资源，以指导临床和处方医生与资深医生的接触 和其他慢性疼痛人群。

Abstract/Project Summary Understanding the role of the pharmaceutical industry in propelling the current opioid crisis in the U.S. is an essential strategy for preventing future epidemics. Using multiple forms of textual data and innovative methodologies for data mining and triangulation, this project examines the specific impacts of industry efforts to target military veterans as opioid consumers and analyzes how new industry-driven narratives, or scripts, about opioid analgesics were circulated. Veterans have many vulnerabilities and are one of the populations most severely impacted by the opioid crisis and opioid-related harms, including overdose and HIV/HCV infection. Important documents emerging in litigation against pharmaceutical companies establish that veterans were targeted as an important consumer niche through advocacy groups and paid accounts from veterans about the benefits of opioid therapies. However, only a small portion of the documents currently being revealed in the process of legal discovery have been examined by public health researchers, and very little is currently known about broader industry agendas and the processes by which pro-pharma narratives became part of veteran-specific health discourse, driving attitudes toward opioids and raising barriers to non-opioid pain management. To identify the themes and elucidate the processes by which these scripts were internalized by different veteran populations, this mixed-method research will triangulate large datasets of pharmaceutical industry marketing and legal documentation with veteran-themed publications and the lived experience of chronic pain patients. Findings will be translated into deliverables which positively impact pain management policy, practice, and the attitudes and expectations of veterans with chronic pain. The scientific team includes veterans and scientists at the forefront of uncovering how the tobacco industry targeted military personnel and veterans, along with experts on opioid use and pharmaceutical industry litigation. The systematic textual and content analyses in this study represent a critical case study in pharmaceutical industry efforts to change prescribing policy and popular culture and will serve as an important contribution to literature on the natural history of drug crises and to clinical approaches to pain by achieving the following aims: Aim 1: Use textual mining technology and analytic methods refined by tobacco researchers to explicate the pharmaceutical industry's campaign to influence veterans' (and veterans service organizations') perceptions opioid therapies, particularly within the context of chronic pain management. Aim 2: Conduct qualitative interviews among veterans with histories of pain and opioid use to understand sociocultural meanings and cognitive scripts that impede safe, effective, and medically-appropriate care. Aim 3: Based on a synthesis of data from Aims 1 and 2, conduct T0 and T1 translational research to generate concrete best practices, tools, and web resources to guide clinical and prescriber engagement with veteran and other chronic pain populations.