Assessing the Safety and Effectiveness of Opioid Tapering in Large Health Systems

项目摘要 美国同时面临两起突发公共卫生事件：阿片类药物过量和 冠状病毒病2019年(新冠肺炎)。新冠肺炎大流行可能导致服药过量增加 通过广泛的卫生服务中断，其中包括专门为慢性病患者提供的服务 处方或非处方的阿片类药物暴露。在卫生系统中实施的保健提供的变化 包括暂停非关键服务和关闭诊所，以及公共卫生措施，如 社会距离和隔离，可能会造成及时护理的障碍。中断护理，如阿片类药物剂量 变异性和停药可能会导致不良的健康后果，包括阿片类药物过量。这些 大流行的影响可能在不同的亚群中不均衡地经历，有可能加强和 加剧健康差距。该项目的总体目标是进行纵向队列研究，以 审查对大型卫生系统中卫生和卫生服务的潜在不同影响。我们的具体目标是： (1)在长期服用阿片类药物(LTOT)的患者中，表征阿片类止痛剂和 纳洛酮处方模式、阿片类药物剂量变异性和停用、初级保健利用和阿片类药物 在新冠肺炎大流行之前和期间服药过量，以及按种族/族裔和性别对新冠肺炎进行检测；以及 (2)在阿片类药物使用障碍(OUD)患者中，丁丙诺啡治疗OUD和OUD的变化特征 纳洛酮处方模式、成瘾治疗利用和阿片类药物过量 新冠肺炎大流行和新冠肺炎按种族/民族和性别进行测试。我们将利用数据系统 在父母赠款(阿片类药物安全数据链接路径[POSD])中开发，其中包含超过 科罗拉多州和威斯康星州有250万人。我们将研究卫生服务的变化 在治疗前和治疗中使用长期阿片类药物治疗并有阿片使用障碍(OUD)的患者 2019年至2020年新冠肺炎大流行。我们的发现将为解决未充分利用的战略提供参考 在新冠肺炎大流行期间为弱势人群提供适当的医疗保健，包括改善 提供护理，扩大获得减少伤害措施的机会，以及有针对性的新冠肺炎测试。

PROJECT ABSTRACT The United States is confronting two concurrent public health emergencies of opioid overdoses and the coronavirus disease 2019 (COVID-19). The COVID-19 pandemic may contribute to increases in overdose through widespread disruptions of health services, which include services specific to patients with chronic opioid exposure, either prescribed or non-prescribed. Changes to care delivery implemented in health systems including suspension of non-critical services and clinic closures, along with public health measures such as social distancing and quarantine, can create barriers to timely care. Disruptions to care, such as opioid dose variability and discontinuation, may lead to adverse health outcomes, including opioid overdose. These impacts of the pandemic may be unevenly experienced across subpopulations, with potential to reinforce and exacerbate health disparities. The overall goal of this project is to conduct a longitudinal cohort study to examine potential disparate impacts on health and health services in large health systems. Our specific aims: (1) In patients prescribed long-term opioid therapy (LTOT), characterize changes in opioid analgesic and naloxone prescribing patterns, opioid dose variability and discontinuation, primary care utilization, and opioid overdose before and during the COVID-19 pandemic and COVID-19 testing by race/ethnicity and gender; and (2) In patients with opioid use disorder (OUD), characterize changes in buprenorphine treatment for OUD and naloxone prescribing patterns, addiction treatment utilization, and opioid overdose before and during the COVID-19 pandemic and COVID-19 testing by race/ethnicity and gender. We will leverage a data system developed in the parent grant (Pathways to Opioid Safety Datalink [POSD]) that contains data on more than 2.5 million people in Colorado and Wisconsin. We will examine changes in health services in cohorts of patients prescribed chronic opioid therapy and with an opioid use disorder (OUD) before and during the COVID-19 pandemic from 2019 to 2020. Our findings will inform strategies to address under-utilization of appropriate healthcare during the COVID-19 pandemic among vulnerable populations, including improved delivery of care, expanded access to harm reduction measures, and targeted COVID-19 testing.