Summer 2016

In this Issue: Improving the Safety of Prescription Opioid Use among Veterans » Table of Contents

A Patient-Centered Intervention to Improve Opioid Safety

Ongoing Study

The use of opioid medications to treat chronic pain is associated with significant adverse events, including medical side effects, misuse, and abuse. Unfortunately, there are currently no evidence-based treatments available to reduce prescription opioid misuse or other adverse events in the primary care setting. This ongoing randomized controlled trial (October 2015 - September 2019) will compare outcomes from two different strategies to improve the safety of opioid medications. Specific aims of the study are to:

• Evaluate whether a multi-faceted intervention (Improving the Safety of Opioid Prescribing, or ISOP) enhances opioid safety;
• Assess whether participation in ISOP impacts the clinician-patient relationship; and
• Explore to what extent ISOP is associated with changes in pain intensity, function, quality of life, and/or depressive symptoms.

Currently in the initial recruitment phase, investigators in this study will randomize primary care providers (PCPs) at the VA Portland Healthcare Center to either ISOP or the control condition; patients will be nested by clinician status. All PCPs will participate in either a two-hour educational workshop – or in the two-hour educational workshop in addition to the nurse care manager (NCM) component. The NCM will maintain a registry of enrolled patients, track urine drug test (UDT) administrations and results, and notify PCPs and provide decision support when patients have evidence of abnormal or unusual medication-related behaviors. The decision support will address best practices for modifying treatment for patients who misuse prescription opioids. The NCM also will meet individually with enrolled participants to discuss strategies for preventing/reducing opioid side effects, preventing diversion, and providing rationale for screening for prescription opioid misuse. Investigators will recruit Veterans who are already prescribed chronic opioid therapy for chronic non-cancer pain. Participants will be enrolled for one year. Outcomes will be measured at baseline, and 6 and 12 months following enrollment.

Impact

Study results are expected to provide a pragmatic intervention to assist VA primary care providers in reducing prescription opioid misuse and other adverse effects, and improving Veterans' satisfaction with care.

View study abstract

Principal Investigator: Benjamin Morasco, PhD, is part of HSR&D's Center to Improve Veteran Involvement in Care (CIVIC) in Portland, OR.

References

1. America's Addiction to Opioids: Heroin and Prescription Drug Abuse. Senate Caucus on International Narcotics Control, May 14, 2014. National Institute on Drug Abuse.

2. Childress S. Veterans Face Greater Risks amid Opioid Crisis. FRONTLINE. March 28, 2016.