PROJECT SUMMARY The population of Americans who are free of cancer 5-years post-cancer diagnosis, long-term survivors, is growing. Many are expected to develop and suffer from chronic pain, of which, many will be prescribed opioids for chronic pain management, contrary to prescribing guidelines. Previous literature has demonstrated that cancer survivors may experience prolonged opioid use or higher rate of opioid prescribing or are more likely to receive a high dose of prescription opioid than individuals who have not been diagnosed with cancer. However, these previous studies are from outside the United States or are regional (e.g. Texas), have a different definition of cancer survivor (e.g. beginning from date of diagnosis, 5 years post-cancer diagnosis), have not examined the roles that providers and hospitals may have on patient high-risk opioid use, and have not assessed the risk of an opioid related adverse outcomes. Furthermore, no studies have examined if federal rescheduling of hydrocodone was successful in reducing rate of high-risk prescription opioid use by cancer survivors. Therefore, this study proposes to address these gaps in a population of older, ≥66 years of age, cancer survivors by utilizing linked SEER-Medicare administrative claims for older cancer survivors diagnosed with lung, colorectal, breast, and prostate cancer through the completion of three specific aims, as follows: 1) Investigate the pattern of high-risk opioid use by years since diagnosis and examine differences by age, sex, race, cohort for year of diagnosis, cancer diagnosis, and by region AND assess if Hydrocodone Rescheduling was associated with a reduction of rate of high-dose opioid therapy for older, long-term cancer survivors; 2) Examine the patient, provider, and hospital factors associated with high-risk opioid use; 3) Assess if long-term cancer survivors, compared to non-cancer controls, have a higher risk of experiencing high-risk opioid use and an opioid related ED visit or hospitalization. We will utilize prevalence rates and interrupted time series, generalized estimating equations, and Cox proportional hazard models and Fine and Gray regression models (for assessing competing risk of death) to analyze aims 1, 2, 3, respectively. The long-term goal of this project is to inform providers, professional organizations, and policy makers about high-risk opioid use rates in cancer survivors, the potential harms of opioids, and previous successes policy attempts to reduce opioid prescribing in cancer survivors. Derrick will receive further training in statistics, epidemiology, patient centered outcomes research, and writing which will be crucial to finishing the proposed project and his future as a clinician-scientist. During his clinical years, Derrick will be involved in research that aims to study patient’s perspectives and patient reported outcomes. Throughout the three years of funding, Derrick will disseminate the results of his research in the form...