In this Issue: Improving the Safety of Prescription Opioid Use among Veterans
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Parallel to increased opioid prescribing in the U.S., the rate of prescription opioid-specific overdoses increased 293% between 1999 and 2009. In 2010, prescription opioids were involved in 58% of all overdose deaths in which the drug(s) responsible was recorded. Moreover, prior studies indicate that Veterans receiving care in the VA healthcare system have approximately twice the risk of overdose compared to the general population. Investigators in this ongoing randomized controlled trial (July 2015 - June 2019)created a brief, tailored intervention to reduce overdose risk behavior for patients in the VA primary care-mental health (PC-MH) integrated setting. The intervention will use a motivational interviewing (MI) counseling approach with cognitive behavioral strategies in order to:
- Provide tailored feedback on risks associated with opioid use,
- Elicit commitment talk to reduce patients' overdose risk behavior and over-reliance on opioids for pain management, and
- Impart specific cognitive and behavioral "tools" related to pain management and safe use of opioids.
Study investigators will then recruit patients from primary care clinics at the VA Ann Arbor Healthcare System and randomize them to either the tailored MI intervention or a psychoeducational control group. Veterans in either group will receive an approximately half-hour session of the tailored MI intervention or the psychoeducational comparison condition delivered by trained therapists who are part of the PC-MHI clinic. Veterans will be re-interviewed over one year of follow-up. Study outcomes will include self-reported overdose risk behavior, opioid use and misuse, and adverse effects of opioid use. Investigators will use VA data to examine opioid medication fills.
This study will increase our understanding of strategies to reduce adverse outcomes related to opioid pain medication use and misuse, namely, risk of overdose, among VA primary care patients. In addition, study findings may have broad implications for improving the safety of opioid use, and consequently the quality of pain care for current and future VA patients.
View study abstract
Principal Investigator: Amy Bohnert, PhD, MHS, is part of HSR&D's Center for Clinical Management Research (CCMR) in Ann Arbor, MI.