The Impact of Discontinuing Medications for Opioid Use Disorder After Surgery: Evaluating Predictors and Outcomes to Guide Perioperative Care

Stanford University, Stanford CA

Investigators

Abstract

PROJECT SUMMARY / ABSTRACT Medications for opioid use disorder (MOUD) decrease risk of relapse, overdose, and death in individuals with opioid use disorder (OUD) and have been studied extensively in non-surgical patients. However, even once patients initiate MOUD—which is meant to be used on a long-term or even lifelong basis—a large proportion discontinue it, often following stressful or painful events. In surgical patients with OUD, there is still a critical gap in understanding how exposure to acute pain via surgery affects postoperative MOUD discontinuation vs treatment retention and sequelae including longer-term, comprehensive addiction-related, pain-related, and all- cause outcomes. The central hypothesis for this study is that risk of postoperative MOUD discontinuation varies by both fixed and modifiable clinical factors and that postoperative MOUD discontinuation is a risk factor for OUD-related adverse events. The rationale for the proposed research program is that it is expected to inform the development of interventions aimed at safely guiding patients with OUD through the perioperative period while helping to establish my independence as a physician-scientist. The central hypothesis will be tested through two specific aims: 1) Identify risk factors for discontinuation of MOUD after surgery and develop a risk calculator to predict MOUD discontinuation, and 2) Estimate the association between postoperative MOUD discontinuation and adverse outcomes in surgical patients. These aims will be achieved via a retrospective cohort study and state-of-the-art statistical methods for causal inference in observational studies. The proposed research is innovative because it will leverage three large, nationally representative claims databases and apply sophisticated statistical methods to estimate postoperative MOUD discontinuation and its association with longer-term adverse postoperative outcomes. The research project is significant because it is expected to provide real-world, actionable guidance on the perioperative management of OUD, benefiting the growing population of patients who live with OUD as a chronic condition and will require surgery in their lifetimes. This work will be critically informative for future research led by the candidate on perioperative practices that decrease risk of adverse postoperative events in patients with OUD. The proposed integrated research and training will be accomplished at Stanford University with the support of an exceptional mentorship team. The candidate will build on a solid background in anesthesiology, public health, and health services research to gain relevant expertise in pain and addiction medicine, advanced statistical methods for health services research, usage of Medicaid claims data, and scientific communication. Together, the research and training will advance the candidate’s long-term goal to develop an independent research program as a physician-scientist aimed at improving prevention and treatment of substance use disorders in patients with acute or chronic pain. Ultimately, the continuum of research will have a positive impact by providing a strong evidence base for targeted specialty care of the growing and vulnerable population of patients with OUD.