February 2020

In This Issue: Advancements in VA Primary Care
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Primary Care Intervention to Reduce Prescription Opioid Overdoses

Feature Article

Takeaway:  Knowledge from this study should have broad implications for improving the safety of opioid use and, consequently, the quality of pain care for current and future VA patients.

Opioid medications are prescribed for chronic pain in the U.S., generally, and in the VA healthcare system. Previous studies conducted by this study team indicate that VA patients have approximately twice the risk of overdose compared to the general population, and being prescribed greater amounts of opioids is associated with higher risk of prescription opioid overdose; further, 76% of VA patients who die of an opioid medication overdose were seen in primary care in the year prior to death. While efforts are underway to address prescriber behavior related to opioids (i.e., the VA Opioid Safety Initiative), concurrent strategies that address patient behavior are needed. Therefore, this ongoing HSR&D study (July 2015 – September 2020) is evaluating a brief, tailored motivational enhancement (ME) intervention to reduce overdose risk behavior for Veterans in the VA primary care setting.

The intervention included in this randomized controlled trial will incorporate ME, as well as cognitive-behavioral strategies to provide tailored feedback regarding risks associated with opioid use, elicit commitment talk to reduce patients' overdose risk behavior and use of complementary non-opioid strategies for pain management, and will impart specific cognitive and behavioral "tools" related to pain management and safe use of opioids. Specific objectives are to:

• Examine whether patients randomly assigned to a ME brief intervention for overdose prevention report reduced overdose risk behavior over one year of follow-up compared to an enhanced usual care condition (EUC, in this case, standard delivery of VA opioid informed consent process); and
• Determine if patients randomly assigned to a ME brief intervention report reduced prescription opioid use over one year of follow-up compared to the EUC condition.

Study investigators have recruited patients who have risk factors indicating elevated risk for prescription opioid overdose from primary care clinics at the VA Ann Arbor Healthcare System in Michigan. Measured over one year, outcomes will include overdose risk behavior, opioid use and misuse, and adverse effects of opioid use.

Findings

None at this time.

Impact

The study will increase VA’s understanding of strategies to reduce adverse outcomes related to opioid medication use and misuse, namely, risk of overdose, among VA primary care patients. Knowledge from this study should have broad implications for improving the safety of opioid use and, consequently, the quality of pain care for current and future VA patients.

Principal Investigator: Amy Bohnert, PhD, MHS, is part of HSR&D’s Center for Clinical Management Research (CCMR), Ann Arbor, MI.

View study abstract