The Impact of Surgery on Outcomes for Patients taking Medications for Opioid Use Disorder
Project Number5R01DA057943-02
Former Number1R01DA057943-01
Contact PI/Project LeaderNGUYEN, THUY DIEU Other PIs
Awardee OrganizationUNIVERSITY OF MICHIGAN AT ANN ARBOR
Description
Abstract Text
PROJECT SUMMARY
Medications for opioid use disorder (MOUD)–buprenorphine, methadone, and naltrexone–decrease illicit opioid
use, increase retention in treatment, and save lives. In the United States, 2.7 million persons live with opioid
use disorder and opioid-related overdose deaths totaled more than 80,000 in 2021. For patients taking MOUD,
and buprenorphine in particular, the treatment of acute pain after surgery is very challenging. Patients on
MOUD who use buprenorphine, as well as methadone, develop tolerance to opioid analgesics. Historically,
perioperative guidelines have advocated that patients temporarily discontinue buprenorphine before surgery,
out of concern that continuing buprenorphine would lead to escalation in opioid dosing and the inability to treat
acute pain after surgery. However, the national conversation has recently shifted with guidelines
recommending that buprenorphine, and to a lesser extent methadone, be continued in the perioperative
setting. The evidence supporting this change has relied on small samples, non-surgical cohorts, and studies
failing to examine relevant outcome for pain and opioid use disorder. As a result, clinicians currently operate in
a clinical and policy environment with no high-quality evidence supporting these conflicting guidelines on the
perioperative care for these vulnerable patients with opioid use disorder. Therefore, rigorous research on how
retention to therapies of buprenorphine, as well as the two other MOUD, influences outcomes after surgery is
critically needed. In this proposal, we will use several state-of-the-art national databases to achieve a better
understanding of perioperative management of buprenorphine and other MOUD. In doing so, we will examine
the consequences of buprenorphine therapy retention on opioid overdose risk and other relevant health
outcomes among privately insured, Medicaid, and Medicare patients under perioperative conditions. We will
focus primarily on buprenorphine, and also include methadone, naltrexone, and mixed MOUD use in this
analysis of patients aged 15 years and above, which accounts for age groups that experience high risk for
initiation of opioid use disorder (older adolescents) and rapid increases in opioid use disorder diagnoses (older
adults). In Aim 1, we will delineate variation in the impact of surgery on the retention of buprenorphine and
other MOUD therapies while providing the most up-to-date information on national patterns of MOUD treatment
retention after surgery. These analyses will also identify factors that predict retention of treatment after surgery.
In Aim 2, we will evaluate whether MOUD treatment retention after surgery is associated with postoperative
opioid prescribing and clinical outcomes. In Aim 3, we will assess whether MOUD treatment retention after
surgery is associated with reductions in opioid overdose events and mortality. Findings from this proposal will
inform efforts to optimize the perioperative management of buprenorphine and other MOUD, and accelerate
efforts to improve the perioperative care and reduce the negative consequences of opioid-related harms
among patients living with opioid use disorder.
Public Health Relevance Statement
PROJECT NARRATIVE
Clinicians currently operate in a clinical and policy environment with no high-quality evidence supporting
optimal guidelines on the perioperative care for patients on OUD who undergo surgical procedures. Using
state-of-the-art national databases and rigorous methods, we will generate the most comprehensive data
analyses to date on the landscape of perioperative management of buprenorphine and other MOUD as well as
its consequences on opioid overdose risk and other health outcomes in privately insured, Medicaid, and
Medicare patients aged 15 years and above. Findings from this proposal will inform efforts to optimize the
perioperative management of buprenorphine and other MOUD, thus informing optimized perioperative efforts
to reduce opioid-related morbidity and mortality for patients with OUD.
NIH Spending Category
No NIH Spending Category available.
Project Terms
15 year oldAccelerationAcuteAcute PainAdolescentAdverse eventAdvocateAgeAmericanBindingBuprenorphineCessation of lifeClinicalConflict (Psychology)DataData AnalysesDatabasesDiagnosisDoseEmergency department visitEnvironmentEuphoriaEventExpert OpinionFailureFormulationGeographic FactorGeographyGuidelinesHealthHealth Care CostsHeterogeneityHospitalizationInsuranceKnowledgeKnowledge ManagementLength of StayMedicaidMedicareMedication ManagementMethadoneMethodsMinorMorbidity - disease rateNaltrexoneOperative Surgical ProceduresOpioidOpioid AnalgesicsOpioid agonistOutcomeOverdosePainPain managementPatient CarePatient-Focused OutcomesPatientsPatternPerioperativePerioperative CarePersonsPoliciesPostoperative PainPostoperative PeriodPractice GuidelinesPredictive FactorPrevalencePrivatizationProviderRaceRecommendationResearchRisk ReductionSamplingUnited StatesVariantaddictionage groupantagonistcohortcomorbidityexperiencehigh riskhospital readmissionillicit opioidimprovedinterestmedical specialtiesmedication for opioid use disordermortalityolder adultopioid overdoseopioid useopioid use disorderoverdose deathoverdose riskpain outcomepatient retentionpopulation basedpragmatic implementationprescription opioidpreventprovider factorsreceptorrelapse riskrespiratorysurgical paintreatment duration
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