Project Summary/Abstract
The intersection of Opioid Use Disorder (OUD) and Alcohol Use Disorder (AUD) presents a significant public
health challenge, particularly in clinical settings where their co-occurrence complicates treatment outcomes and
exacerbates the severity of each disorder. Despite advancements in pharmacotherapy for OUD and AUD
independently, the treatment of these co-occurring disorders remains underexplored, especially in large-scale,
real-world contexts. Our research aims to address this gap by leveraging the Oracle Cerner EHR Real-World
Data (CRWD), a comprehensive national database encompassing over 100 million patients, to conduct an
extensive analysis of treatment patterns, outcomes, and predictive factors in patients with co-occurring OUD and
AUD. Our study is structured around three specific aims. The first aim is to assess the effectiveness of integrated
treatment approaches, including first-line AUD and OUD medications along with glucagon-like peptide-1 receptor
agonists (GLP-1 RA), for patients with co-occurring OUD and AUD. We will focus on evaluating the reduction in
substance use, improvements in physical health indicators, mental health improvements, and the utilization of
detoxification services and drug tests. We hypothesize that patients receiving integrated treatment regimens will
exhibit better outcomes, such as lower rates of alcohol intoxication and opioid overdose, improved liver function,
reduced hospitalization, and alleviated mental health symptoms. The second aim is to identify demographic,
racial, and clinical factors that predict adherence to treatment regimens in patients with co-occurring OUD and
AUD. We will examine the consistency of medication orders, the duration and dosage consistency of prescribed
treatments, and the alignment of medication orders with clinical appointments. Our hypothesis is that specific
demographic and clinical characteristics will significantly influence treatment adherence, with variations
observed across different patient groups. The third aim is to investigate the impact of stable and consistent
comprehensive treatment engagement on long-term recovery outcomes in individuals with co-occurring OUD
and AUD. We will measure relapse rates and durations of abstinence, hypothesizing that patients who
demonstrate stable and consistent engagement in their treatment process will exhibit lower relapse rates and
longer durations of abstinence. This research is innovative in its approach to leveraging a national database to
address the complexities of co-occurring OUD and AUD. It is particularly innovative in exploring GLP-1 RA as a
potential therapeutic agent in the treatment of these co-occurring disorders. By integrating this novel approach
with traditional pharmacotherapies and evaluating its effectiveness using a large-scale national database, this
study aims to contribute significantly to addiction medicine. The findings have the potential to inform clinical
practice and public health policy, leading to more effective and personalized treatment strategies for individuals
affected by these disorders. Ultimately, this research will provide empirical evidence to guide the development
of new clinical guidelines or updates to existing procedures and policies in treating co-occurring OUD and AUD.
