# Role of disability and pain in opioid overdose: mechanism and risk mitigation

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2024 · $599,488

## Abstract

Drug overdose deaths in the US have increased exponentially, driven by opioid overdoses. Concurrently,
US surveillance studies have documented increased disability prevalence among adults in midlife. People
with disabilities have higher rates of opioid use disorder (OUD) but are less likely to receive treatment for
it, putting them at higher risk for opioid overdose. Despite these established risks, people with disabilities
remain an understudied subpopulation in the context of the opioid crisis. Much of heightened risk among the
disabled population may be due to chronic pain. Many people with physical disability experience chronic pain
that either drives the disability, termed “high-impact chronic pain”, or that occurs concurrently. Chronic pain is
frequently managed with prescription opioids, sometimes via risky prescribing practices. In addition to chronic
pain, pathways through depression or through loss of economic opportunity and its accompanying stressors
may link physical disability to overdose risk. Opioid prescribing for chronic pain has been linked to increased
risk of opioid overdose, but any such risk conferred by having a physical disability, disentangled from chronic
pain, has not been estimated—nor has the risk associated with co-occurring physical disability and chronic
pain. Moreover, the mechanisms through which disability and chronic pain operate to affect overdose risk are
unknown. Availability of recommended treatments for substance use disorders (SUDs), including OUD, and
chronic pain may influence the relationships, mechanisms, and the associated disparities we propose to study,
but is highly variable across localities. The objectives of this project are: Aim 1) to estimate the unique and
joint contributions of physical disability and chronic pain conditions to opioid overdose risk and the extent to
which pain management practices mediate these relationships; Aim 2) to develop novel statistical methods to
transport mediated effects from one state to another, and to apply those methods in Aim 3) to identify SUD and
pain management treatment metrics that, if improved, may reduce both overall overdose risk associated with
physical disability and chronic pain and disparities in overdose risk by racial/ethnic-gender subgroup. We will
harness geographic variation in the delivery of SUD and pain management treatment and predict the effects
that realistic improvements in delivery would have on reducing opioid overdose in this vulnerable population.
The proposed research is expected to estimate the extent to which physical disability increases risk of opioid
overdose, the proportion of that increased risk attributable to chronic pain and attendant risky pain manage-
ment practices (versus non-chronic pain mechanisms), and the extent to which risk may be mitigated by
improvements in delivering appropriate chronic pain management and SUD (including OUD) treatment. This
will allow for future prevention strategies to be tailored to the...

## Key facts

- **NIH application ID:** 10763014
- **Project number:** 5R01DA053243-03
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Kara Elizabeth Rudolph
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $599,488
- **Award type:** 5
- **Project period:** 2022-03-01 → 2027-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10763014

## Citation

> US National Institutes of Health, RePORTER application 10763014, Role of disability and pain in opioid overdose: mechanism and risk mitigation (5R01DA053243-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10763014. Licensed CC0.

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