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Introduction:We summarize the 2018 AUA (American Urological Association) Quality Improvement Summit, Opioid Stewardship in Urology, highlighting appropriate urological opioid use as well as...

IMPACT: This is the first examination of risk factors for prolonged opioid use after an ICU stay and will inform efforts to strengthen prescribing guidelines and care transition models for patients after critical illness. OBJECTIVES/GOALS: The majority of patients in intensive care units (ICU) receive opioids during admission, and up to 25% receive a prescription at discharge. However, transitions of care and prolonged use after discharge remain unknown. We aim to characterize risk factors for prolonged opioid use after an ICU stay. METHODS/STUDY POPULATION: A retrospective study using insurance claims from Optum Clinformatics ®Data Mart was conducted for opioid-naive adult patients (18-64 years) with an ICU admission from 2010 to 2019. The primary outcome was new persistent opioid use, defined as a continued prescription fill 91-180 days after discharge, in addition to a fill in the first 90 days. The primary exposure was an opioid fill at discharge. The ICU admission was characterized using the Clinical Classification System from the Agency of Healthcare Research and Quality, based on patients’primary diagnosis code. Diagnoses were combined into 11 groups highlighting the affected organ system/mechanism of injury. Logistic regression evaluated the associations of patient demographic and clinical characteristics with the probability of persistent opioid use. RESULTS/ANTICIPATED RESULTS: In this cohort of 90,721 patients discharged from the ICU, 3.3% continued to fill opioids at 6 months. An opioid prescription fill (OR 3.1; 95% CI 28 - 3.3) and benzodiazepine prescription fill (OR 1.6; 95% CI 1.4 - 1.8) within 3 days of ICU discharge were each significantly associated with the development of new persistent opioid use. Patient diagnosis groups of Musculoskeletal/Trauma (OR 2.3; 95% CI 2.0 - 2.6), Neoplasms (OR 1.6; 95% CI 1.5 - 1.9), and GI/Hepatobiliary (OR 1.5; 95% CI 1.3 - 1.8) were significantly more likely to develop new persistent use when compared to the Cardiovascular diagnosis group. DISCUSSION/SIGNIFICANCE OF FINDINGS: Opioid prescriptions at discharge after an ICU stay increase the odds of prolonged opioid use. These results will inform efforts to strengthen prescribing guidelines and care models after a critical illness. Further work will characterize the trajectory of prescribing and patient exposure to high-risk prescribing after ICU discharge.

The United States faces a crisis due to the high prevalence of chronic pain and associated opioid use disorder and overdose deaths. While the majority of acute pain resolves within weeks, 20-50% of people with acute pain persists well beyond the initial insult. The mechanisms driving the transition from acute to chronic pain states are poorly understood. Through a National Institutes of Health (NIH)-funded initiative, the A2CPS Program was formed to identify putative biomarkers (individual or biosignature combinations) that predict susceptibility or resilience for the transition from acute to chronic pain after surgery (total knee replacement and thoracotomy). The A2CPS consortium includes two multisite clinical centers (MCCs), one Clinical Coordinating Center (CCC), one Data Integrations and Research Center (DIRC), and 3 OMICS centers along with representation from the NIH Pain Consortium, Common Fund, and National Institute of Drug Abuse. During an initial planning year, the A2CPS developed study aims, biomarker selection, and a study protocol. Candidate biomarkers were selected across multiple domains (clinical, biospecimen, psychosocial, and brain structure/function). Data will be collected from two MCCs (n=3600 individuals) before, during and after surgery to determine factors that predict the transition from acute to chronic pain 6 months later. Subjects will be comprehensively phenotyped across measures of pain, behavioral and psychological, quantitative sensory testing, brain imaging, proteomics, genomics, metabolomics, and lipidomics. Determining biomarkers prior to and in the acute phase after surgery could provide the basis for interventions to prevent the onset of chronic pain and contribute to our understanding of the dynamic processes underlying the transition from acute to chronic pain. Furthermore, if any of the predictive biomarkers play a mechanistic role in development of chronic pain, then the molecules, pathways, constructs, and/or brain circuits identified could serve as new potential therapeutic targets for reversing chronic pain or increasing patients’ resilience. National Institutes of Health Grants: NS112873, NS118922, DA049110, NS112874, DA049115, DA049116, DA049113.