Addressing Opioid Use Disorder in Older Adults through Primary Care Innovation (OUD-PCI)
ABSTRACT The Agency for Healthcare Research and Quality and other agencies are exploring specific aspects of opioid and pain management among older adults seen in primary care settings. Those over 65 years old or suffering from conditions that cause pain that significantly limits their functioning (e.g., physical, mental or psychological disabilities) are at considerably higher risk for adverse effects of opioid medications. Chronic pain in these individuals may have multiple causes and can manifest through multiple types of pain. Non-cancer chronic pain may interact with multiple health conditions in a more complex manner. The pharmacodynamics and pharmacology of opioids may be altered significantly at an older age due to physiological changes and polypharmacy (resulting in drug-drug interactions and more adverse effects) becomes a much greater challenge. Furthermore, the same patients may experience decreased autonomy, self-efficacy, resilience, and social support, while the healthcare system may struggle to effectively and safely coordinate their increasingly complex care. These synergistic risk factors converge on the ability of patients and their primary care doctors to optimize the management of chronic pain, requiring more carefully designed and innovative healthcare approaches. Most current pain management interventions have been developed for a typically younger population that may more frequently demonstrate opioid abuse, while few programs or resources are available that are tailored to adults who are older or at higher risk. These individuals are more likely to be harmed by opioids that they receive in the course of regular clinical therapy. Therefore, addressing the specific needs and health challenges of these populations through innovation and careful tailoring of existing pain management strategies is urgently needed. Based on these considerations, our team designed a multi-faceted, person- centered and scalable chronic pain management program to be implemented in Oklahoma primary care practices that is systematically tailored to older adults and those with functional disabilities or increased social risk. Our innovative approach is anchored in best practices and resources that we have developed in past studies. Our proposed initiative will help primary care practices optimize pain management approaches in older adults through an integrated and trans-disciplinary application of advances in multi-modal pain management, pain-mechanism-based pharmacotherapy, personalized and goal-oriented care that focuses on functional capacity, implementation science, evidence-based quality improvement methodology, and community-engaged design.