Project Summary/Abstract In 2016, the Centers for Disease Control (CDC) released guidelines recommending non-pharmacologic treatment for chronic pain over use of opioid analgesia in response to rising overdose deaths and based on studies showing nonopioid and multidisciplinary approaches to pain contribute to functional and pain severity improvements. CDC guidelines also recommended opioid tapering for chronic pain patients with substance use disorder (SUD) and transition to medications for opioid use disorder (MOUD) for patients with co-occurring opioid use disorder (OUD). While opioid tapering has been widely implemented, few studies assess transitions to MOUD or multidisciplinary medicine use specifically among patients with chronic pain and co-occurring SUD. A primary reason for this limited knowledge is the population with chronic pain and co-occurring SUD is often relatively small in any given healthcare facility or system, and outcomes of interest may occur in low total numbers. Thus, a large database is required to conduct multifactorial research on outcomes associated with different approaches to opioid tapering, especially when evaluating whether trends hold among smaller demographic groups. To address this critical gap, our goal is to create weights for the Cerner Real-World© database, which includes electronic health records (EHR) data from over 100 million unique U.S. patients at 600 participating hospitals and clinics. Our hypothesis is that weighting the database will significantly enhance its representativeness in order to longitudinally assess the relationship between opioid tapering, multidisciplinary medicine, MOUD, and outcomes for chronic pain patients with co-occurring SUD. Our aims are to use American Hospital Association and U.S. Census data to create weights, stratified by hospital characteristics and adjusted by demographic variables, for analyzing the Cerner database (Aim 1); validate the weighting scheme in Aim 1 by comparing weighted estimates from the Cerner database to estimates from a well-established population (the Nationwide Inpatient Sample) for chronic pain, SUD, and overdose diagnoses and relevant multidisciplinary pain interventions for the years 2000-2025 (Aim 2); among patients with chronic pain and co-occurring OUD, examine how tapering opioid analgesics and transitioning to MOUD affects risk for overdose, suicide, and other hospitalizations, and assess how sex and race/ethnicity operate as effect modifiers in these relationships (Aim 3); and among patients with chronic pain and co-occurring SUD, examine how tapering opioid analgesics while using multidisciplinary pain treatment affects risk for overdose, suicide, and other hospitalizations, and assess how sex and race/ethnicity operate as effect modifiers in these relationships (Aim 4). This project will create a national database with validated weighting that will enable rigorous examination of opioid tapering approaches among patients with chronic pain and co-occurring SUD, which will subsequently improve knowledge of how multidisciplinary pain treatment and MOUD affect risks, while considering tapering-related inequities among demographic subpopulations.

Project Narrative 2016 Centers for Disease Control (CDC) guidelines recommend opioid tapering for chronic pain patients with substance use disorder (SUD) and transition to medications for opioid use disorder (MOUD) for patients with co- occurring opioid use disorder (OUD). While opioid tapering has been widely implemented by providers, few studies assess transitions to MOUD or multidisciplinary medicine use specifically among patients with chronic pain and co-occurring SUD, and thus knowledge is limited on outcomes associated with these approaches to tapering for this high-risk patient population. The proposed study will utilize both American Hospital Association data and U.S. Census data to create weights for the Cerner Real-World© database to longitudinally assess the relationship between opioid tapering, multidisciplinary medicine, MOUD, and outcomes for chronic pain patients with co-occurring SUD and examine how sex and race/ethnicity operate as effect modifiers in these relationships.