Prescription Opioid Discontinuation: Honoring Patient Insights and Experience to Support Safe and Caring Transitions -- Decision Aid Pilot

Patient Perspectives on Prescription Opioid Discontinuation: Understanding and Promoting Safe Transitions

Because of recent policies to decrease opioid use, some people using long-term opioid therapy (LTOT) are encouraged or required to stop (discontinue) taking opioids. That has led experts to be concerned that patients whose LTOT is discontinued could have untreated pain, turn to other substance use and possibly illicit opioids, or have worsened mental health symptoms leading to suicide. To guide safer policies, guidelines, and care, this study will interview patients and doctors about discontinuing LTOT and use the results to develop a patient-centered decision aid (DA) to improve patient-provider communication around discontinuation of LTOT. Once the DA is finalized, it will be pilot tested with a group of 30 patients who are currently on LTOT. The pilot will assess DA implementation feasibility; acceptability; knowledge transfer; and ability to successfully foster positive, patient-centered conversations about opioid discontinuation.

EHR-based inclusion criteria:

• age 18 or older
• LTOT in the past 18 months (LTOT is ≥60 days of ≥50 MEDs day in each of 2 consecutive 90-day periods with medication treatment for OUD excluded)

Inclusion criteria confirmed by participant

• Have been taking opioids for chronic pain for at least 6 months
• Able to speak and read English

EHR-based exclusion criteria:

• cancer diagnosis in the last 5 years (excluding non-melanoma skin cancers)
• current palliative or hospice care
• cognitive disability
• psychiatric hospitalization in the last year
• surgery in the last 6 months
• current residence in an inpatient rehabilitation or skilled nursing facility

Exclusion criteria determined by study

- participated in an interview for Aim 1 of this study