Pain, Multimorbidity, Opioid-Drug Interactions and Risk for Opioid Use Disorder or Overdose in Older Adults

这项研究建议在老年人中进行纵向研究，以评估失控疼痛的关联， 共同发生的慢性病或老年症状(多发病)，以及阿片类药物与风险的相互作用 阿片类药物使用障碍(OUD)或过量(OD)。这项研究回应了AHRQ的特殊兴趣(非HS- 21-010)在研究中解决物质使用障碍，包括老年人的OUD和OD。老年人 在过去十年中经历了OUD或OD的显著增长，尽管 阿片类药物处方，表明迫切需要确定处方阿片类药物使用以外的因素 到OUD/OD，为老年人口的干预提供信息。疼痛、多种疾病和多种药物，所有这些都很强烈 与年龄增长有关，经常被认为是老年人OUD/OD的潜在危险因素，但 缺乏相关证据。缓解疼痛是老年人滥用阿片类药物最常见的动机，但 无法控制的疼痛在多大程度上对OUD/OD的风险有贡献尚不清楚。多发病在以下疾病中非常普遍 患有OUD或OD的老年人，但其与无法控制的疼痛和 多发病和不受控制的疼痛与OUD/OD的风险尚不清楚。人们对此的理解也很有限 关于疼痛治疗处方阿片类药物与药物同时使用时OUD/OD的风险 其他可能与老年人阿片类药物相互作用的慢性并存疾病。为了填补这些研究空白，这项研究 拟议的研究将利用100%的联邦医疗保险样本和与全国代表性相关联的联邦医疗保险数据 研究疼痛、多发病和阿片类药物相互作用与风险之间关系的纵向调查数据 用于患有慢性疼痛的老年人的OUD/OD结果。具体地说，我们将检查这些关联 被诊断为慢性疼痛并接受治疗的老年人的疼痛控制与OUD或OD风险之间的关系 处方类阿片。我们还将评估多发病与疼痛控制及其关节的关系。 与老年患者的OUD/OD风险相关。此外，我们将评估并发使用的程度 阿片类药物与治疗老年人常见慢性疼痛并存疾病的药物相关 与患有慢性疼痛的老年人的OUD/OD结果有关。我们将测量疼痛和高冲击性疼痛，并 通过基于诊断的指数和以下老年症状的存在来量化多病 诊断不足或无法诊断。我们的研究将在多大程度上提供经验证据 无法控制的疼痛、多发病和阿片类药物相互作用可能在增加OUD或OD的风险中发挥作用。 在患有慢性疼痛的老年人中。鉴于美国老龄化人口的加速增长和 OUD、服药过量和阿片类药物滥用持续增加，我们的数据将为综合护理 慢性疼痛和其他慢性并存情况，以改善疼痛控制，同时减少老年人的OUD或OD 成年人。

This study proposes longitudinal research among older adults to assess the associations of uncontrolled pain, co-occurring chronic conditions or geriatric symptoms (multimorbidity), and opioid–drug interactions with risk for opioid use disorder (OUD) or overdose (OD). This study is responsive to AHRQ’s special interest (NOT-HS- 21-010) in research to address substance use disorders, including OUD and OD in older adults. Older adults have experienced significant increases in OUD or OD in the last decade despite a decrease in the number of opioid prescriptions, signaling an urgent need to identify factors beyond prescription opioid use that contribute to OUD/OD to inform interventions in older populations. Pain, multimorbidity, and polypharmacy, all strongly associated with advancing age, are frequently noted as potential risk factors for OUD/OD in older adults, but relevant evidence is lacking. Relieving pain is the most frequent motive for opioid misuse in older adults, but to what extent uncontrolled pain contributes to risk for OUD/OD is unknown. Multimorbidity is highly prevalent in older adults with OUD or OD, but its association with uncontrolled pain and the joint association of multimorbidity and uncontrolled pain with risk for OUD/OD are unknown. There is also limited understanding regarding the risk of OUD/OD when prescription opioids for pain treatment are concurrently used with drugs for other chronic comorbid conditions that may interact with opioids in older adults. To fill these research gaps, this proposed study will leverage a 100% Medicare sample and Medicare data linked to nationally representative longitudinal survey data to study the associations of pain, multimorbidity, and opioid-drug interactions with risk for OUD/OD outcomes of older adults with chronic pain. Specifically, we will examine the associations between pain control and risk for OUD or OD in older adults diagnosed with chronic pain and treated with prescription opioids. We will also evaluate the association of multimorbidity with pain control and their joint association with OUD/OD risk in older patients. Furthermore, we will assess the extent to which concurrent use of opioids with drugs for treating common comorbid conditions with chronic pain in older adults is associated with OUD/OD outcomes in older adults with chronic pain. We will measure both pain and high-impact pain and quantify multimorbidity through both a diagnosis-based index and the presence of geriatric symptoms that are underdiagnosed or not diagnosable. Our study will provide empirical evidence on the extent to which uncontrolled pain, multimorbidity, and opioid-drug interactions may play a role in increasing risk for OUD or OD among older adults with chronic pain. Given the accelerated growth of the US aging population and the continuing increase in OUD, OD, and opioid misuse, our data will inform interventions that integrate care for chronic pain and other chronic comorbid conditions to improve pain control while reducing OUD or OD in older adults.