Primary Care Intervention to Reduce Prescription Opioid Overdoses (POST)
Pain, Drug Overdose, Opioid Use Disorders
About this trial
This is an interventional treatment trial for Pain focused on measuring Opioid analgesics, Primary care, Veterans, Motivational interviewing, Cognitive behavioral therapy, Self-efficacy, Behavioral symptoms, Injuries, Opioid Safety
Eligibility Criteria
Inclusion Criteria:
- Patient at the Ann Arbor VA Medical Center receiving treatment in a primary care clinic
- Currently prescribed 20 morphine-equivalent mg (MEM) per day or more of an opioid
- Received opioid therapy for at least 90 days
- 18 years of age or older
Exclusion Criteria:
- Plans to stop opioids or reduce dose to below 20 MEM/day in the next 6 months
- Use of fentanyl, due to the difficulty in determining morphine equivalency
- A terminal cancer diagnosis
- Acute suicidality requiring immediate treatment
- Moderately severe cognitive impairment
- Inability to give informed consent
Sites / Locations
- VA Ann Arbor Healthcare System, Ann Arbor, MI
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Motivational Intervention
Enhanced Usual Care
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.
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.