Dr. Erin Fanning Madden and her collaborator at Loyola University Chicago, Dr. Fares Qeadan, were awarded a five-year $2 million grant from the National Institutes of Health-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 this study led by Dr. Qeadan, along with Dr. Pooja Lagisetty (University of Michigan) and Dr. Philip Kroth (Western Michigan University) as additional co-investigators.

Centers for Disease Control guidelines released in 2016 recommended tapering for chronic pain patients with substance use disorders who received long-term opioid treatment. The guideline 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 this 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, few studies actually assess such transitions to multidisciplinary interventions or medication treatment for opioid addiction for the particularly high-risk patient population with co-occurring chronic pain and substance use disorders. A primary reason for our limited knowledge is this population is often relatively small in any given healthcare facility or system, and outcomes of interest may occur in low total numbers. To address this critical gap, this new study will create weights for the Cerner Real-World© database, which is 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 SUD and examine how sex and race/ethnicity operate as effect modifiers in these relationships.

Dr. Madden is a substance use researcher whose work primarily uses qualitative and community-engaged approaches to examining stigma. She will be supporting this research project by convening and leading a community advisory board of patients with co-occurring chronic pain and substance use disorders. This 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.

Award number: 1R01DA057658-01