Mentoring Junior Investigators to Tackle the Opioid Epidemic

摘要 我的总体目标是推进遏制阿片类药物流行所需的证据，并将证据转化为 转化为现实世界的执行和有效的公共卫生政策。目前在美国流行的阿片类药物是 由处方阿片类药物(POS)广泛用于治疗慢性疼痛推动。作为回应，指南和健康 政策越来越多地促进阿片类药物风险缓解战略的使用，如PO缩减(减少剂量或 停止采购订单)。然而，阿片类药物风险缓解战略的采用速度超过了证据，因为 例如，PO缩减的结果和在现实世界艾滋病毒和艾滋病中实施PO缩减的最佳战略 初级保健设置未知。PO缩减可能会对艾滋病毒控制产生特别严重的影响，如果 逐渐减少会导致患者脱离艾滋病毒护理，或者用非法或注射的阿片类药物取代POS；但风险 这些结果没有量化，与这些结果相关的因素也没有说明。给定 总体上缺乏关于PO风险缓解战略及其实施的证据，以及 应对疫情，当务之急是扩大临床医生-调查人员指导患者- 针对HIV+和HIV感染者使用PO的定向研究。我是一名治疗慢性疼痛和阿片类药物的医生 使用障碍，十多年来专注于明智的PO处方的调查员，以及具有 良好的辅导记录和特殊的机构资源，以支持受训者。这是职业生涯中期的K24 研究员奖将通过以下方式帮助扩大临床医生研究人员在该领域的能力：1)提供杰出的 对初级研究人员的指导，重点是PO在慢性疼痛中的使用，2)扩大我在 实施科学方法论，以优化将证据转化为实践，以及3)推进我的 作为将关于PO使用的证据转化为指南和卫生政策的领导者而发展。我的坚强 现有的研究计划侧重于针对HIV+和HIV慢性病患者的PO风险缓解做法 Pain，连同出色的顾问和机构资源，将提供一个指导和 扩展我的技能。使用我现有的研究队列和新的主要数据收集，包括定性 通过访谈和离散选择实验，我们提出了以下新的研究目标：1)考察 在患有慢性疼痛的HIV+和HIV患者中，PO缩减的积极和消极结果，以及2)到 确定HIV+患者和HIV慢性病患者对不同PO缩减策略的偏好 疼痛和高风险的PO使用。所有拟议的研究都将与被辅导者一起进行，并将提供充足的 在多样化的研究方法、负责任的研究行为方面为学员提供发展机会，以及 准备稿件和拨款申请。研究结果将为未来的干预和 PO缩减的指导方针。总体而言，拟议的指导、职业发展和研究计划将 扩大能力以应对阿片类药物的流行。

ABSTRACT My overall goal is to advance the evidence needed to stem the opioid epidemic, and to translate the evidence into real-world implementation and effective public health policy. The current opioid epidemic in the US was driven by widespread use of prescription opioids (POs) for chronic pain. In response, guidelines and health policies increasingly promote use of opioid risk mitigation strategies such as PO tapering (reducing the dose or discontinuing POs). However, adoption of opioid risk mitigation strategies is outpacing the evidence, for example, outcomes of PO tapering and optimal strategies for implementing PO tapering in real-world HIV and primary care settings are unknown. PO tapering can have particularly serious implications for HIV control, if tapering causes patients to fall out of HIV care or replace POs with illicit or injected opioid use; but the risks have not been quantified and factors associated with these outcomes have not been described. Given the overall lack of evidence about PO risk mitigation strategies and their implementation and the urgency of addressing the epidemic, it is imperative to expand the capacity of clinician-investigators conducting patient- oriented research on PO use in HIV+ and HIV- individuals. I am a physician who treats chronic pain and opioid use disorder, an investigator focused on judicious PO prescribing for over a decade, and an educator with a strong mentoring track record and exceptional institutional resources to support mentees. This K24 mid-career investigator award will help to expand capacity of clinician investigators in the field by: 1) providing outstanding mentorship to junior investigators focused on PO use in chronic pain, 2) expanding my research in implementation science methodologies to optimize translating evidence into practice, and 3) advancing my development as a leader in translating evidence about PO use into guidelines and health policy. My strong existing research program focused on PO risk mitigation practices for HIV+ and HIV- patients with chronic pain, along with exceptional advisors and institutional resources, will provide a platform for mentoring and expanding my skills. Using my existing study cohorts and new primary data collection including qualitative interviews and a discrete choice experiment, we propose the following new research aims: 1) to examine the positive and negative outcomes of PO tapering among HIV+ and HIV- patients with chronic pain, and 2) to identify patient preferences for different PO tapering strategies among HIV+ and HIV- patients with chronic pain and high-risk PO use. All proposed research will be conducted with mentees and will provide ample opportunities for mentee development in diverse research methods, responsible conduct of research, and preparing manuscripts and grant applications. Findings from the research will inform future interventions and guidelines for PO tapering. Overall, the proposed plans for mentoring, career development, and research will expand capacity to address the opioid epidemic.