The Impact of Depression Treatment on Suicide and Overdose Among Patients Receiving Prescription Opioids (Administrative Supplement to R01DA045055)

项目摘要/摘要 同时患有疼痛和抑郁的人--尤其是那些接受处方阿片类药物治疗的人 镇痛剂--自杀、过量服药和其他与阿片类药物相关的伤害的风险显著增加。给定 近年来，自杀和吸毒过量的发生率不断上升，迫切需要解决这些问题 通过确定防止自杀和其他阿片类药物的有效战略，交织在一起的国家公共卫生危机- 与此相关的伤害，特别是对患有疼痛和抑郁的弱势人群。改善访问权限 抑郁症治疗是一种可能有希望的策略：抑郁症通常被低估和 疼痛患者治疗不足，尽管有效的药理和非药理作用 治疗方法是存在的，可以改善疼痛和情绪症状。然而，关于这一点的证据很少 抑郁症治疗对阿片类药物治疗患者自杀和过量用药的影响 止痛药。 我们目前由NIDA资助的R01的目标是：阿片类药物危机：阿片类药物的影响和意外后果 国家关于阿片类止痛药处方的政策，包括审查阿片类药物处方与 模式和不利的患者结果。在这份行政副刊中，我们将把这项工作扩展到审查 研究不足但高危亚群的慢性疼痛患者的预后 未被识别的抑郁症，并评估抑郁症治疗作为潜在的中介因素在 阿片类药物使用与包括自杀在内的阿片类药物相关危害之间的关系。 我们的具体目标如下。首先，我们将考察县级处方率与 阿片类镇痛剂和抗抑郁药，以及随着时间的推移的自杀率和过量服药率。第二，使用个人- 级别的商业索赔数据，我们将检查药理学和非药理学之间的关联 治疗抑郁症、服药过量、故意自残和其他与阿片类药物相关的伤害 在个人水平分析中使用处方阿片类药物治疗。我们还将评估可能的异构性 根据患者的临床和人口学特征、抑郁症治疗的质量、 阿片类药物处方模式和其他背景因素。本研究将推进亲本R01的S目标 加强应对阿片类药物滥用、过量用药和自杀等公共卫生危机。

PROJECT SUMMARY/ABSTRACT Individuals with comorbid pain and depression – particularly those who are treated with prescription opioid analgesics – have a markedly increased risk of suicide, overdose and other opioid-related harms. Given the rising incidence of both suicide and drug overdose in recent years, there is an urgent need to address these intertwined national public health crises by identifying effective strategies to prevent suicide and other opioid- related harms, particularly for vulnerable populations with comorbid pain and depression. Improving access to depression treatment is one strategy that may hold promise: depression is commonly underdiagnosed and undertreated in individuals with pain, despite the fact that effective pharmacologic and non-pharmacologic treatments exist and can improve both pain and mood symptoms. There is a paucity of evidence, however, on the impact of depression treatments on suicide and overdose among patients who are treated with opioid analgesics. The goals of our current NIDA-funded R01, “The Opioid Crisis: The Effects and Unintended Consequences of State Policies on Opioid Analgesic Prescribing,” include examining the relationship between opioid prescribing patterns and adverse patient outcomes. In this administrative supplement we will extend this work to examine outcomes for the understudied yet high-risk subpopulation of patients with chronic pain who may have unrecognized depression, and to assess the role of depression treatment as a potential mediating factor in the relationship between opioid use and opioid-related harms including suicide. Our specific aims are as follows. First, we will examine the relationship between county-level prescribing rates for opioid analgesics and antidepressants, and suicide and overdose rates over time. Second, using individual- level commercial claims data, we will examine the association between pharmacologic and non-pharmacologic treatments for depression, and overdose, intentional self-harm and other opioid-related harms among patients treated with prescription opioids in individual-level analyses. We will also assess for possible heterogeneous effects according to patients' clinical and demographic characteristics, the quality of depression treatment, opioid prescribing patterns and other contextual factors. This research will advance the parent R01's goal of strengthening our response to the public health crises of opioid misuse, overdose and suicide.