A Joint Survival Modeling and Therapy Knowledge Graph Framework to Characterize Opioid Use Disorder Trajectories

Abstract

Motivation: Opioid use disorder (OUD) often arises after prescription opioid exposure and follows transitions among onset, remission, and relapse. Linked EHR-survey resources such as the All of Us Research Program enable stage-specific risk modeling and connection to intervention options. Results: We built a multi-stage framework to model time-to-onset, time-to-remission, and time-to-relapse after remission using All of Us EHR and survey data. For each participant we derived longitudinal predictors from clinical conditions and survey concepts, including recent (1/3/12-month) event counts, cumulative exposures, and time since last event. We fit regularized Cox models for each transition and aggregated selection frequencies and hazard ratios to identify a compact set of high-confidence predictors. Pain, mental health, and polysubstance use contributed across stages: chronic pain syndromes, tobacco/nicotine dependence, anxiety and depressive disorders, and cannabis dependence prominently predicted onset and relapse, whereas tobacco dependence during remission and other remission-coded conditions were strongly associated with transition to remission. To support therapeutic prioritization, we constructed a therapy knowledge graph integrating genetic targets, biological pathways, and published evidence to map identified risk factors to candidate treatments in recent OUD studies and clinical guidelines.