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The high rate of adverse events, including overdose, resulting from opioid pain medication use threatens the quality and safety of pain care in the Veterans Health Administration (VHA) and elsewhere and is a critical public health problem in the United States. Pain is a highly common condition among VHA patients, and opioid therapy constitutes a primary mode of pain treatment.
This study seeks to address this issue by conducting a randomized controlled trial of a brief conversation to improve opioid safety among Veteran patients receiving long-term opioid therapy. Veterans receiving opioid therapy for pain in primary care will be recruited and randomized to receive either a single session motivational intervention focused on safe opioid use or an equal attention control condition. The primary hypothesis is that the motivational intervention will improve opioid safety, decrease risk behaviors, aberrant opioid use, and total quantities of opioids prescribed relative to the control condition. Study findings will inform efforts to ensure the safety and well-being of Veteran patients with pain.
Adverse outcomes, including overdose, related to opioid use have increased and represent a significant threat to the safety and quality of VHA pain care as well as a national public health concern. Efforts are underway to change opioid prescribing behavior, but concurrent strategies are needed to address patient behaviors that decrease opioid safety and thus increase opioid overdose risk. Overdoses result from a range of behaviors, including taking more than prescribed, using multiple substances with synergistic effects, and injecting/snorting crushed pills to get high. Factors such as having a mental health condition have been found to increase risk of overdose among Veterans receiving opioids for pain. Given the range of risk behaviors and relevant patient factors, tailored opioid risk reduction strategies are urgently needed. Motivational enhancement (ME) is an evidence-based strategy that uses tailoring to enact behavior change through improving self-efficacy and motivation. Recent VHA initiatives to increase behavioral health providers in primary care, such as Primary Care-Mental Health Integration (PC-MHI), provide a clear opportunity to deliver ME interventions to the many patients treated for long-term pain in primary care. Although the impact of ME on overdose risk behavior is unknown, the use of an ME approach to improve opioid safety and reduce risk behaviors is potentially well-suited to the context of long-term opioid pain care, when total and immediate discontinuation of opioid use is often unfeasible.
The proposed Prescription Opioid Safety Trial (POST) study will be a randomized controlled trial of a brief, tailored ME conversation that incorporates cognitive behavioral strategies to increase pain coping and is aimed at improving patients' opioid safety. The study will recruit 450 patients from primary care clinics at the VA Ann Arbor Healthcare System. Patients with long-term opioid use, defined as treatment for at least 84 days covered within the last 90 days, who are prescribed opioid doses of 20 morphine-equivalent mg/day or greater (an indicator of overdose risk) will be screened and recruited into the study. Participants will then be randomized to either the intervention (n = 225) or an enhanced usual care (EUC) condition (n = 225). Pharmacy records and patient self-report will be assessed at baseline and 3-, 6-, and 12-month follow-ups to measure key outcomes.
The specific aims are:
Aim 1) to examine if patients randomly assigned to a brief opioid safety intervention report reduced overdose risk behaviors (e.g., higher dose, concurrent alcohol use, concurrent other drug/medication use, returning to normal dose after breaks in use) over one year of follow-up compared to patients assigned to equal attention EUC.
Aim 2) to examine if patients randomly assigned to a brief opioid safety intervention have lower total quantities of opioids prescribed (from pharmacy fill records) and aberrant opioid use (e.g., using for reasons other than pain, obtaining opioids from someone other than primary provider) over one year of follow-up compared to patients assigned to equal attention EUC.
The study has two secondary aims: 1) to examine if patients randomly assigned to the brief intervention have fewer non-fatal overdoses and other medication-related adverse events (emergency department visits, over-sedation, injuries), better functioning, and more often store and dispose of opioids safely compared to patients assigned to EUC; and 2) to examine mediators (motivation and self-efficacy) and moderators (OIF/OEF/OND status, baseline mental health) of intervention effects.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Motivational Intervention | Experimental | The intervention session combines elements of motivational enhancement (ME) and cognitive behavioral therapy (CBT) and uses the structure of ME brief interventions. The motivational session is overlaid on the VA long-term opioid therapy informed consent process. |
|
| Enhanced Usual Care | Active Comparator | In addition to covering the VHA's long-term OA informed consent process, the enhanced usual care (EUC) condition provides educational content related to the biology of pain response and an overview of pain conditions. The overall style is didactic. This EUC condition will include some information related to risks of opioid use as part of the informed consent and will consequently have sufficient face validity as an intervention on opioid safety to effectively blind participant to randomization. However, the EUC therapist will not use the motivational enhancement approach of discussing strategies for avoiding these risks. It is designed to be equal in length to the motivational intervention. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Motivational intervention | Behavioral | The intervention session combines elements of motivational enhancement (ME) and cognitive behavioral therapy (CBT). Similar to other ME brief interventions, the intervention content will be covered in a single session. Participants are presented with a variety of risk reduction strategies and strategies for coping with pain that may reduce reliance on opioids for managing pain. |
| Measure | Description | Time Frame |
|---|---|---|
| Overdose Risk Behaviors | This scale is a total sum of 9 items assessing participant's self-report of engaging in behavior that increases risk for overdose. Higher scores indicate greater risk for overdose. The range for this measure is 0 to 9 in one assessment. | 3-, 6-, and 12-months post-baseline |
| Aberrant Opioid Use | This measure contained 8 self-reported items from the Current Opioid Misuse Measure. Items were assessed on a scale of "never (0)," "rarely (1)," "sometimes (2)," "often (3)," and "very often (4)." A sum score took a range of 0 to 32, with higher numbers indicating more non-medical opioid use. | 3-, 6-, and 12-months post-baseline |
| Average Number of Days Prescribed Opioid Use Based on Pharmacy Records | Number of days prescribed opioid use was pulled from pharmacy records. For follow-up periods, times no dose were included to create averages over periods. Patients without medications during their follow-up period were included with a dose of zero. | 3-, 6-, and 12-months post-baseline |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With Non-fatal Overdose Experiences | This scale is the number of overdose experiences as self-reported in the Overdose Experiences questionnaire. This item is a number of participants whom endorsed having experienced an overdose at that time period. | 3-, 6-, and 12-months post-baseline |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Amy S Bohnert, PhD MHS BA | VA Ann Arbor Healthcare System, Ann Arbor, MI | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA Ann Arbor Healthcare System, Ann Arbor, MI | Ann Arbor | Michigan | 48105-2303 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35122753 | Result | Humphreys K, Shover CL, Andrews CM, Bohnert ASB, Brandeau ML, Caulkins JP, Chen JH, Cuellar MF, Hurd YL, Juurlink DN, Koh HK, Krebs EE, Lembke A, Mackey SC, Larrimore Ouellette L, Suffoletto B, Timko C. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet. 2022 Feb 5;399(10324):555-604. doi: 10.1016/S0140-6736(21)02252-2. Epub 2022 Feb 2. No abstract available. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Motivational Intervention | The intervention session combines elements of motivational enhancement (ME) and cognitive behavioral therapy (CBT) and uses the structure of ME brief interventions. The motivational session is overlaid on the VA long-term opioid therapy informed consent process. Motivational intervention: The intervention session combines elements of motivational enhancement (ME) and cognitive behavioral therapy (CBT). Similar to other ME brief interventions, the intervention content will be covered in a single session. Participants are presented with a variety of risk reduction strategies and strategies for coping with pain that may reduce reliance on opioids for managing pain. Long-term opioid therapy informed consent: The Veterans Health Administration instituted a requirement that all patients receiving long-term opioid therapy receive an informed consent process that reviews the risks of opioid therapy. All individuals eligible for this study will meet this definition of long-term opioid therapy. The study therapists for both study arms will deliver the informed consent process during the sessions as part of treatment as usual. |
| FG001 | Enhanced Usual Care | In addition to covering the VHA's long-term OA informed consent process, the enhanced usual care (EUC) condition provides educational content related to the biology of pain response and an overview of pain conditions. The overall style is didactic. This EUC condition will include some information related to risks of opioid use as part of the informed consent and will consequently have sufficient face validity as an intervention on opioid safety to effectively blind participant to randomization. However, the EUC therapist will not use the motivational enhancement approach of discussing strategies for avoiding these risks. It is designed to be equal in length to the motivational intervention. Psycho-educational control: The educational control condition provides educational content related to the biology of pain response and an overview of pain conditions. The overall style is didactic. Long-term opioid therapy informed consent: The Veterans Health Administration instituted a requirement that all patients receiving long-term opioid therapy receive an informed consent process that reviews the risks of opioid therapy. All individuals eligible for this study will meet this definition of long-term opioid therapy. The study therapists for both study arms will deliver the informed consent process during the sessions as part of treatment as usual. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Motivational Intervention | The intervention session combines elements of motivational enhancement (ME) and cognitive behavioral therapy (CBT) and uses the structure of ME brief interventions. The motivational session is overlaid on the VA long-term opioid therapy informed consent process. Motivational intervention: The intervention session combines elements of motivational enhancement (ME) and cognitive behavioral therapy (CBT). Similar to other ME brief interventions, the intervention content will be covered in a single session. Participants are presented with a variety of risk reduction strategies and strategies for coping with pain that may reduce reliance on opioids for managing pain. Long-term opioid therapy informed consent: The Veterans Health Administration instituted a requirement that all patients receiving long-term opioid therapy receive an informed consent process that reviews the risks of opioid therapy. All individuals eligible for this study will meet this definition of long-term opioid therapy. The study therapists for both study arms will deliver the informed consent process during the sessions as part of treatment as usual. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Overdose Risk Behaviors | This scale is a total sum of 9 items assessing participant's self-report of engaging in behavior that increases risk for overdose. Higher scores indicate greater risk for overdose. The range for this measure is 0 to 9 in one assessment. | Due to lost to follow-up, death, missing data, or participant withdrawal, the number analyzed varied throughout the follow-up periods. | Posted | Mean | Standard Deviation | score on a scale | 3-, 6-, and 12-months post-baseline |
|
Collected over 12 months post-baseline assessment
Adverse events were discovered while completing retention activities, such as EHR checks or calling and talking to family members. All participants were at risk of all-cause mortality, or some unanticipated serious adverse event.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Motivational Intervention | The intervention session combines elements of motivational enhancement (ME) and cognitive behavioral therapy (CBT) and uses the structure of ME brief interventions. The motivational session is overlaid on the VA long-term opioid therapy informed consent process. Motivational intervention: The intervention session combines elements of motivational enhancement (ME) and cognitive behavioral therapy (CBT). Similar to other ME brief interventions, the intervention content will be covered in a single session. Participants are presented with a variety of risk reduction strategies and strategies for coping with pain that may reduce reliance on opioids for managing pain. Long-term opioid therapy informed consent: The Veterans Health Administration instituted a requirement that all patients receiving long-term opioid therapy receive an informed consent process that reviews the risks of opioid therapy. All individuals eligible for this study will meet this definition of long-term opioid therapy. The study therapists for both study arms will deliver the informed consent process during the sessions as part of treatment as usual. |
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During the course of this project, the VA changed their opioid prescribing practices in response to the Opioid Safety Initiative. This changed the potential participants for this study (patients prescribed more than 50 MEM), so we updated our enrollment criteria to 20 MEM. We still did not meet our enrollment goal as we had reached saturation of the potential participant pool of patients in primary care at the local VA hospital. At the same time, our overall retention rate is 87.3%.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Amy Bohnert | Veterans Health Administration | 734-845-3638 | amybohne@med.umich.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 8, 2018 | Nov 3, 2021 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Aug 10, 2017 | Mar 21, 2022 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D010146 | Pain |
| D062787 | Drug Overdose |
| D009293 | Opioid-Related Disorders |
| D001526 | Behavioral Symptoms |
| D014947 | Wounds and Injuries |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D063487 | Prescription Drug Misuse |
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|
| Psycho-educational control | Behavioral | The educational control condition provides educational content related to the biology of pain response and an overview of pain conditions. The overall style is didactic. |
|
| Long-term opioid therapy informed consent | Other | The Veterans Health Administration instituted a requirement that all patients receiving long-term opioid therapy receive an informed consent process that reviews the risks of opioid therapy. All individuals eligible for this study will meet this definition of long-term opioid therapy. The study therapists for both study arms will deliver the informed consent process during the sessions as part of treatment as usual. |
|
| Treatment Utilization |
Number of visits to the emergency department, for medical, mental health or substance use visits, across VA and non-VA hospitals from the Treatment Service Utilization Questionnaire. The numbers reported are the mean number of visits among those participants that had any emergency department visits at each time point. |
| 3-, 6-, and 12-months post-baseline |
| Other (Non-overdose) Injuries From the Revised Injury Behavior Checklist Questionnaire | This scale is the number of non-overdose injuries assessed through the Revised Injury Behavior Checklist questionnaire, focusing on 4 topics (Injury 1. by violence or by being physically attacked; 2. By falling; 3. By a motor vehicle or by being hit by a moving vehicle while walking; 4. While riding a bicycle, skateboard, or rollerblading). This item is a count of participants who responded that they were injured during any of these types of activities and received treatment. | 3-, 6-, and 12-months post-baseline |
| Scores on an Opioid Storage and Disposal Knowledge and Behaviors Questionnaire | This scale assesses safe storage and disposal of prescription opioid medications with 6 items. Items were assessed on a scale of "never (0)," "rarely (1)," "sometimes (2)," "often (3)," and "very often (4)." A sum score took a range of 0 to 24, with higher numbers indicating less safe practices. The sum of the score of the 6 items was used to find the mean scores for those in each arm. | 3-, 6-, and 12-months post-baseline |
| Level of Oversedation as an Opioid Side Effect | The level of oversedation as an opioid side effect was assessed using two items from the Pain Treatment Satisfaction Scale looking at side effects of opioid medications (excessive fatigue and drowsiness). Items were assessed on a scale of 0 (did not experience) to 5 (extremely bothered). A sum score ranged from 0 to 10 with a higher score indicating the potential for more oversedation. | 3-, 6-, and 12-months post-baseline |
| General Physical and Mental Functioning From Short Form-12 Questionnaire Scores | A modified Veterans RAND 12-item health survey was used to assess general health. One item was scored from 1 (Excellent) to 5 (Poor). Score means were compared at baseline and each follow-up. | 3-, 6-, and 12-months post-baseline |
| Pain-specific Disability Score From an Adapted Version of Brief Pain Inventory Questionnaire | This scale is a sub-section of the Brief Pain Inventory that assesses the impact of pain on functioning across 7 different activities. Activities are assessed on a Likert scale from "Does not interfere (0)" to "Completely interferes (10)". BPI pain interference was scored as the mean of the seven interference items, scores range from 0 to 10, with a mean score of 10 (maximum score) indicating a complete interference in all activities. | 3-, 6-, and 12-months post-baseline |
| Withdrawal by Subject |
|
| BG001 | Enhanced Usual Care | In addition to covering the VHA's long-term OA informed consent process, the enhanced usual care (EUC) condition provides educational content related to the biology of pain response and an overview of pain conditions. The overall style is didactic. This EUC condition will include some information related to risks of opioid use as part of the informed consent and will consequently have sufficient face validity as an intervention on opioid safety to effectively blind participant to randomization. However, the EUC therapist will not use the motivational enhancement approach of discussing strategies for avoiding these risks. It is designed to be equal in length to the motivational intervention. Psycho-educational control: The educational control condition provides educational content related to the biology of pain response and an overview of pain conditions. The overall style is didactic. Long-term opioid therapy informed consent: The Veterans Health Administration instituted a requirement that all patients receiving long-term opioid therapy receive an informed consent process that reviews the risks of opioid therapy. All individuals eligible for this study will meet this definition of long-term opioid therapy. The study therapists for both study arms will deliver the informed consent process during the sessions as part of treatment as usual. |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Count of Participants | Participants |
|
| Overdose risk behaviors | This scale is a total sum of 9 items assessing participant's self-report of engaging in behavior that increases risk for overdose. Higher scores indicate greater risk for overdose. The range for this measure is 0 to 9 in one assessment. | Mean | Standard Deviation | units on a scale |
|
| Aberrant opioid use | This measure contained 8 items from the Current Opioid Misuse Measure. Items were assessed on a scale of "never (0)," "rarely (1)," "sometimes (2)," "often (3)," and "very often (4)." A sum score took a range of 0 to 32, with higher numbers indicating more non-medical opioid use. | The number of participants analyzed are adjusted for missing data. | Mean | Standard Deviation | units on a scale |
|
| Average number of days prescribed opioid use based on pharmacy records | Number of days prescribed opioid use was pulled from pharmacy records. For follow-up periods, times no dose were included to create averages over periods. Patients without medications during their follow-up period were included with a dose of zero. | Mean | Standard Deviation | Days of Prescribed Opioid Use |
|
| Participants with non-fatal overdose experiences | This scale is the number of overdose experiences as self-reported in the Overdose Experiences questionnaire. This item is the number of participants whom endorsed having experienced an overdose at that time period. | The number of participants analyzed are adjusted for missing data | Number | Number with Overdose Experiences |
|
| Treatment utilization | Number of visits to the emergency department, for medical, mental health or substance use visits, across VA and non-VA hospitals from the Treatment Service Utilization Questionnaire. The numbers reported are the mean number of visits among those participants that had any emergency department visits at each time point. | Due to lost to follow-up, death, participant withdrawal, or the lack of visits to the emergency department, the number analyzed varied throughout the study. | Mean | Standard Deviation | Number of Visits to the Emergency Dept |
|
| Other (non-overdose) injuries from the Revised Injury Behavior Checklist Questionnaire | This scale is the number of non-overdose injuries assessed through the Revised Injury Behavior Checklist questionnaire, focusing on 4 topics (Injury 1. by violence or by being physically attacked; 2. By falling; 3. By a motor vehicle or by being hit by a moving vehicle while walking; 4. While riding a bicycle, skateboard, or rollerblading). This item is a count of participants who responded that they were injured during any of these types of activities and received treatment. | The number of participants analyzed are adjusted for missing data. | Count of Participants | Participants |
|
| Scores on an opioid storage and disposal knowledge and behaviors questionnaire | This scale assesses safe storage and disposal of prescription opioid medications with 6 items. Items were assessed on a scale of "never (0)," "rarely (1)," "sometimes (2)," "often (3)," and "very often (4)." A sum score took a range of 0 to 24, with higher numbers indicating less safe practices. The sum of the score of the 6 items was used to find the mean scores for those in each arm. | Mean | Standard Deviation | units on a scale |
|
| Level of oversedation as an opioid side effect | The level of oversedation as an opioid side effect was assessed using two items from the Pain Treatment Satisfaction Scale looking at side effects of opioid medications (excessive fatigue and drowsiness). Items were assessed on a scale of 0 (did not experience) to 5 (extremely bothered). A sum score ranged from 0 to 10 with a higher score indicating the potential for more oversedation. | The numbers of participants analyzed are adjusted for missing data. | Mean | Standard Deviation | units on a scale |
|
| General physical and mental functioning from Veteran Short Form questionnaire scores | A modified Veterans RAND 12-item health survey was used to assess general health. One item was scored from 1 (Excellent) to 5 (Poor). Score means were compared at baseline and each follow-up. | The number of participants analyzed are adjusted for missing data. | Mean | Standard Deviation | units on a scale |
|
| Pain-specific disability score | This scale is a sub-section of the Brief Pain Inventory that assesses the impact of pain on functioning across 7 different activities. Activities are assessed on a Likert scale from "Does not interfere (0)" to "Completely interferes (10)". BPI pain interference was scored as the mean of the seven interference items, scores range from 0 to 10, with a mean score of 10 (maximum score) indicating a complete interference in all activities. | The number of participants analyzed are adjusted for missing data. | Mean | Standard Deviation | units on a scale |
|
| OG001 | Enhanced Usual Care | In addition to covering the VHA's long-term OA informed consent process, the enhanced usual care (EUC) condition provides educational content related to the biology of pain response and an overview of pain conditions. The overall style is didactic. This EUC condition will include some information related to risks of opioid use as part of the informed consent and will consequently have sufficient face validity as an intervention on opioid safety to effectively blind participant to randomization. However, the EUC therapist will not use the motivational enhancement approach of discussing strategies for avoiding these risks. It is designed to be equal in length to the motivational intervention. Psycho-educational control: The educational control condition provides educational content related to the biology of pain response and an overview of pain conditions. The overall style is didactic. Long-term opioid therapy informed consent: The Veterans Health Administration instituted a requirement that all patients receiving long-term opioid therapy receive an informed consent process that reviews the risks of opioid therapy. All individuals eligible for this study will meet this definition of long-term opioid therapy. The study therapists for both study arms will deliver the informed consent process during the sessions as part of treatment as usual. |
|
|
| Primary | Aberrant Opioid Use | This measure contained 8 self-reported items from the Current Opioid Misuse Measure. Items were assessed on a scale of "never (0)," "rarely (1)," "sometimes (2)," "often (3)," and "very often (4)." A sum score took a range of 0 to 32, with higher numbers indicating more non-medical opioid use. | Due to lost to follow-up, death, missing data, or participant withdrawal, the number analyzed varied throughout the follow-up periods. | Posted | Mean | Standard Deviation | score on a scale | 3-, 6-, and 12-months post-baseline |
|
|
|
| Primary | Average Number of Days Prescribed Opioid Use Based on Pharmacy Records | Number of days prescribed opioid use was pulled from pharmacy records. For follow-up periods, times no dose were included to create averages over periods. Patients without medications during their follow-up period were included with a dose of zero. | All participants were included in this analysis as this was taken from Electronic Health Records and did not rely on follow-up survey responses. | Posted | Mean | Standard Deviation | Days of Prescribed Opioid Use | 3-, 6-, and 12-months post-baseline |
|
|
|
| Secondary | Number of Participants With Non-fatal Overdose Experiences | This scale is the number of overdose experiences as self-reported in the Overdose Experiences questionnaire. This item is a number of participants whom endorsed having experienced an overdose at that time period. | Due to lost to follow-up, death, missing data, or participant withdrawal, the number analyzed varied throughout the follow-up periods. The Overall Number of Participants Analyzed includes participants with at least one outcome assessment at each timepoint. | Posted | Number | participants with OD | 3-, 6-, and 12-months post-baseline |
|
|
|
| Secondary | Treatment Utilization | Number of visits to the emergency department, for medical, mental health or substance use visits, across VA and non-VA hospitals from the Treatment Service Utilization Questionnaire. The numbers reported are the mean number of visits among those participants that had any emergency department visits at each time point. | Due to lost to follow-up, death, missing data, participant withdrawal, or the lack of visits to the emergency department, the number analyzed varied throughout the study. | Posted | Mean | Standard Deviation | Visits to the Emergency Dept | 3-, 6-, and 12-months post-baseline |
|
|
|
| Secondary | Other (Non-overdose) Injuries From the Revised Injury Behavior Checklist Questionnaire | This scale is the number of non-overdose injuries assessed through the Revised Injury Behavior Checklist questionnaire, focusing on 4 topics (Injury 1. by violence or by being physically attacked; 2. By falling; 3. By a motor vehicle or by being hit by a moving vehicle while walking; 4. While riding a bicycle, skateboard, or rollerblading). This item is a count of participants who responded that they were injured during any of these types of activities and received treatment. | Due to lost to follow-up, death, missing data, or participant withdrawal, the number analyzed varied throughout the follow-up periods. | Posted | Count of Participants | Participants | 3-, 6-, and 12-months post-baseline |
|
|
|
| Secondary | Scores on an Opioid Storage and Disposal Knowledge and Behaviors Questionnaire | This scale assesses safe storage and disposal of prescription opioid medications with 6 items. Items were assessed on a scale of "never (0)," "rarely (1)," "sometimes (2)," "often (3)," and "very often (4)." A sum score took a range of 0 to 24, with higher numbers indicating less safe practices. The sum of the score of the 6 items was used to find the mean scores for those in each arm. | Due to lost to follow-up, death, missing data, or participant withdrawal, the number analyzed varied throughout the follow-up periods. | Posted | Mean | Standard Deviation | score on a scale | 3-, 6-, and 12-months post-baseline |
|
|
|
| Secondary | Level of Oversedation as an Opioid Side Effect | The level of oversedation as an opioid side effect was assessed using two items from the Pain Treatment Satisfaction Scale looking at side effects of opioid medications (excessive fatigue and drowsiness). Items were assessed on a scale of 0 (did not experience) to 5 (extremely bothered). A sum score ranged from 0 to 10 with a higher score indicating the potential for more oversedation. | Due to lost to follow-up, death, missing data, or participant withdrawal, the number analyzed varied throughout the follow-up periods. The Overall Number of Participants Analyzed includes participants with at least one outcome assessment at each timepoint. | Posted | Mean | Standard Deviation | score on a scale | 3-, 6-, and 12-months post-baseline |
|
|
|
| Secondary | General Physical and Mental Functioning From Short Form-12 Questionnaire Scores | A modified Veterans RAND 12-item health survey was used to assess general health. One item was scored from 1 (Excellent) to 5 (Poor). Score means were compared at baseline and each follow-up. | Due to lost to follow-up, death, missing data, or participant withdrawal, the number analyzed varied throughout the follow-up periods. The Overall Number of Participants Analyzed includes participants with at least one outcome assessment at each timepoint. | Posted | Mean | Standard Deviation | score on a scale | 3-, 6-, and 12-months post-baseline |
|
|
|
| Secondary | Pain-specific Disability Score From an Adapted Version of Brief Pain Inventory Questionnaire | This scale is a sub-section of the Brief Pain Inventory that assesses the impact of pain on functioning across 7 different activities. Activities are assessed on a Likert scale from "Does not interfere (0)" to "Completely interferes (10)". BPI pain interference was scored as the mean of the seven interference items, scores range from 0 to 10, with a mean score of 10 (maximum score) indicating a complete interference in all activities. | Due to lost to follow-up, death, missing data, or participant withdrawal, the number analyzed varied throughout the follow-up periods. The Overall Number of Participants Analyzed includes participants with at least one outcome assessment at each timepoint. | Posted | Mean | Standard Deviation | score on a scale | 3-, 6-, and 12-months post-baseline |
|
|
|
| 3 |
| 147 |
| 0 |
| 147 |
| 0 |
| 147 |
| EG001 | Enhanced Usual Care | In addition to covering the VHA's long-term OA informed consent process, the enhanced usual care (EUC) condition provides educational content related to the biology of pain response and an overview of pain conditions. The overall style is didactic. This EUC condition will include some information related to risks of opioid use as part of the informed consent and will consequently have sufficient face validity as an intervention on opioid safety to effectively blind participant to randomization. However, the EUC therapist will not use the motivational enhancement approach of discussing strategies for avoiding these risks. It is designed to be equal in length to the motivational intervention. Psycho-educational control: The educational control condition provides educational content related to the biology of pain response and an overview of pain conditions. The overall style is didactic. Long-term opioid therapy informed consent: The Veterans Health Administration instituted a requirement that all patients receiving long-term opioid therapy receive an informed consent process that reviews the risks of opioid therapy. All individuals eligible for this study will meet this definition of long-term opioid therapy. The study therapists for both study arms will deliver the informed consent process during the sessions as part of treatment as usual. | 4 | 152 | 0 | 152 | 0 | 152 |
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| D000076064 | Drug Misuse |
| D019966 | Substance-Related Disorders |
| D064419 | Chemically-Induced Disorders |
| D001523 | Mental Disorders |
| D000079524 | Narcotic-Related Disorders |
| D001519 | Behavior |
| Unknown or Not Reported |
|
| Native Hawaiian or Other Pacific Islander |
|
| Black or African American |
|
| White |
|
| More than one race |
|
| Unknown or Not Reported |
|
| 6-Month Follow-up |
|
|
| 12-Month Follow-up |
|
|
| 12-Month Follow-up |
|
| 6-Month Follow-up |
|
|
| 12-Month Follow-up |
|
|
| 6-Month Follow-up |
|
|
| 12-Month Follow-up |
|
|
| 6-Month Follow-up |
|
|
| 12-Month Follow-up |
|
|
| 6-Month Follow-up |
|
|
| 12-Month Follow-up |
|
|
| 6-Month Follow-up |
|
|
| 12-Month Follow-up |
|
|
| 6-Month Follow-up |
|
|
| 12-Month Follow-up |
|
|
| 6-Month Follow-up |
|
|
| 12-Month Follow-up |
|
|