A Patient-Centered Intervention to Improve Opioid Safety

A Patient-Centered Intervention to Improve Opioid Safety

This is a randomized controlled trial of a multifaceted intervention designed to improve the safety of opioid prescribing. The specific aims of this study are to: (a) evaluate whether a multifaceted intervention (Improving the Safety of Opioid Prescribing; ISOP) enhances opioid safety, (b) assess whether participation in ISOP impacts the clinician-patient relationship, and (c) explore to what extent ISOP is associated with changes in pain and pain-related function.

The investigators will randomize primary care providers (PCPs) at the VA Portland Health Care System to either ISOP or the control condition; patients will be nested by clinician status. All PCPs who enroll will participate in either a two-hour educational workshop or the two-hour educational workshop + nurse care manager (NCM). The NCM will maintain a registry of enrolled patients, track opioid medication-related events from the medical record, and provide decision support to PCPs for issues related to prescription opioid safety. The NCM will also 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. The investigators will recruit patients 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 after enrollment.

Inclusion Criteria:

• Enrollment in primary care at the VA Portland Health Care System
• Receiving long-term opioid therapy (for at least 3 months) for chronic pain unrelated to a life-limiting disease
• Able to read and write in English

Exclusion Criteria:

• Age younger than 18 years old
• On opioid therapy for palliative or end-of-life care
• Current enrollment in an opioid substitution program
• Lack of access to a telephone