Erin Fanning Madden, Ph.D., M.P.H., assistant professor in the Department of Family Medicine and Public Health Sciences, and colleagues have secured a five-year, $2 million grant from the National Institutes of Health’s National Institute on Drug Abuse to study outcomes among patients with co-occurring chronic pain and substance use disorders who are tapered off of long-term opioid treatment.
Dr. Madden will serve as a co-investigator on the study, led by Fares Qeadan, Ph.D., associate professor of Public Health Sciences at Loyola University. Co-investigators include Pooja Lagisetty, M.D., M.Sc., assistant professor of Internal Medicine at the University of Michigan, and Philip Kroth, M.D., MS.c., chair of the Department of Biomedical Informatics, and professor of Biomedical Informatics and of Medicine at Western Michigan University.
Guidelines released in 2016 by the U.S. Centers for Disease Control and Prevention recommend tapering for chronic pain patients with substance use disorders who received long-term opioid treatment. The guidelines further promoted the use of multidisciplinary medicine (e.g., physical therapy) and transition to medications for opioid use disorder for patients with co-occurring opioid addiction.
Recent studies highlight a key tension in the shift away from opioid analgesia for chronic pain patients. While some suggest populations of chronic pain patients respond well to tapering and substituting with other pain treatments in a multidisciplinary approach, other research indicates there may be significant risks associated with opioid tapering that actually exacerbate overdose and other health problems.
While opioid tapering has been widely implemented by providers, for the particularly high-risk patient population with co-occurring chronic pain and substance use disorders, few studies assess transitions to multidisciplinary interventions or medication treatment for opioid addiction. A primary reason for limited knowledge is that this population is often relatively small in any given health care facility or system, and outcomes may occur in low numbers.
To address this critical gap, the new study will create weights for the Cerner Real-World© database, a large national electronic medical records database, to longitudinally assess the relationship between opioid tapering, multidisciplinary medicine, medications for opioid use disorders and outcomes for chronic pain patients with co-occurring substance use disorder, and examine how sex and race/ethnicity operate as effect modifiers.
Dr. Madden is a substance use researcher whose work primarily uses qualitative and community-engaged approaches to examining stigma. She will support the project by convening and leading a community advisory board of patients with co-occurring chronic pain and substance use disorders. The board will provide essential expertise from individuals with lived experience of these health conditions.
While many quantitative projects using electronic health records data provide key information about real-world trends, this project will also leverage insight from individuals directly affected by opioid tapering when designing and interpreting quantitative analyses.
The award number for this study is 1R01DA057658-01.