Prevention of Opioid Use Disorder After Surgery: A Pilot and Feasibility Study

美国正处于阿片类药物使用危机之中，其中阿片类药物死亡人数令人不安地上升 过量和阿片类药物使用障碍（OUD）的破坏性个人和社会影响。OUD通常以 处方阿片类药物使用，例如用于治疗术后患者的中度至重度疼痛。 以前的研究表明，大量接受阿片类药物进行普通手术的患者， 程序开发持久的阿片类药物使用，必要的第一步OUD及其后遗症。平衡 手术患者术后疼痛管理的方法是迫切需要的，以防止持续的术后疼痛。 在阿片类药物使用发展之前进行手术，从而有助于阻止阿片类药物使用危机的浪潮，同时仍然 管理病人的疼痛 本研究的目的是设计和试点测试多方面持续使用阿片类药物的可行性 预防计划（MOPP），以支持更安全的阿片类药物处方，自我管理和监测，以及 减少阿片类药物的持续使用和阿片类药物滥用，以帮助患者在主要治疗后过渡到社区环境。 整形外科多方面的干预包括：1）药师主导的出院咨询 和照顾者以及与出院后提供者的沟通; 2）标准化阿片类药物处方出院 每种手术类型的订单集; 3）出院后疼痛管理随访访视（额外联系 根据需要）嵌入常规术后护理中以管理疼痛和阿片类药物使用;以及4）患者 参与疼痛管理应用程序，用于评估疼痛，功能和OUD的可能发展。这些 在以前的慢性阿片类药物使用研究中， 在这一人群中实施或评估，目的是预防阿片类药物的持续使用。的 MOPP的设计及其实施将由患者家庭咨询理事会持续指导， 不同利益攸关方指导委员会和跨学科工作组。的主要结局 干预措施将是基于全州处方数据的持续阿片类药物使用（手术后6个月内）。 次要结局将包括长期阿片类药物发作; 出院;术后6个月内分发的术后阿片类药物总量;自我报告的疼痛，功能， 以及术后90天和180天提示阿片类药物滥用的体征或症状;以及术后 保健利用。我们将衡量干预的可靠性，并使用综合框架， 实施研究（CFIR），以指导患者，护理人员和提供者的定性访谈， 查明执行工作的障碍和促进因素。这些方法将有助于改进执行情况。 为今后的执行工作规划和提供经验教训。这项研究将提供宝贵的 初步数据，以告知更大的研究，设计，实施和评估有效的发展 预防术后患者持续使用阿片类药物和随后的阿片类药物使用障碍的策略。

The United States is in the midst of an opioid use crisis, including a disturbing rise in deaths from opioid overdoses and devastating personal and societal effects of opioid use disorder (OUD). OUD often starts with prescription opioid use, such as for the treatment of moderate to severe pain in post-operative patients. Previous studies have shown that a substantial number of patients who receive opioids for common surgical procedures develop persistent opioid use, a necessary first step towards OUD and its sequelae. A balanced approach to postoperative pain management for surgical patients is urgently needed to prevent persistent post- operative opioid use before it develops, thus helping to stem the tide of the opioid use crisis while still managing patients’ pain. The objective of this study is to design and pilot test the feasibility of a Multi-faceted persistent Opioid use Prevention Program (MOPP) to support safer opioid prescribing, self-administration and monitoring, and reduce persistent opioid use and opioid misuse for patients transitioning to the community setting after major orthopedic surgery. The multi-faceted intervention includes: 1) pharmacist-led discharge counseling of patients and caregivers and communication with post-discharge providers; 2) standardized opioid prescribing discharge order sets for each surgery type; 3) a post-discharge pain management follow-up visit (with additional contact as needed) embedded within routine post-operative care for managing pain and opioid use; and 4) a patient engagement pain management app for assessing pain, function, and possible development of OUD. These components have shown promise in prior studies of chronic opioid use but have not been previously implemented or evaluated in combination in this population with a goal of preventing persistent opioid use. The design of MOPP and its implementation will be continuously guided by a patient-family advisory council and diverse stakeholder steering committee and interdisciplinary working group. The primary outcome of the intervention will be persistent opioid use (in the 6 months after surgery) based on state-wide prescription data. Secondary outcomes will include long-term opioid episodes; morphine-equivalent dose of opioids prescribed at discharge; total post-operative opioids dispensed in the 6 months after surgery; self-reported pain, function, and signs or symptoms suggestive of opioid misuse 90 and 180 days after surgery; and post-operative healthcare utilization. We will measure intervention fidelity and use the Consolidated Framework for Implementation Research (CFIR) to guide qualitative interviews of patients, caregivers, and providers to identify barriers and facilitators of implementation. These approaches will help improve the implementation plan and provide lessons learned for future implementation efforts. The proposed study will provide valuable preliminary data to inform the development of a larger study to design, implement, and evaluate effective strategies to prevent persistent opioid use and subsequent opioid use disorder for post-surgical patients.