Improving Opioid Safety in Veterans Using Collaborative Care and Decision Support
Improving Opioid Safety in Veterans Using Collaborative Care and Decision Support
The investigators propose to develop a novel intervention that targets the system
 (Collaborative Care), PCP (computerized decision support for opioid therapy) and veteran
 (CM-delivered MI) to reduce problematic prescription opioid use and encourage non-opioid pain
 management alternatives.
The investigators will develop and test the acceptability, feasibility, and preliminary
 efficacy of a Collaborative Care intervention in which one of two Care Managers delivering
 both interventions will assist primary care providers (PCPs) by using Motivational
 Interviewing to communicate computer-based ATHENA-OT (opioid therapy) decision support
 guidelines to veterans with chronic pain. Specifically, after honing the intervention, the
 investigators will conduct a pilot randomized controlled trial of Collaborative
 Care/Motivational Interviewing in 100 veterans (ages 18 and older) with chronic pain in
 primary care who are prescribed opioid pain medications and exhibit at least one "high-risk"
 opioid use behavior (e.g. obtaining early opioid refills, etc.). Using ATHENA-OT decision
 support, PCPs will make guideline-concordant recommendations to all enrolled study patients
 and initiate a Pain Care Plan. Veterans randomized to Collaborative Care, will have one MI
 session with their assigned study Care Manager followed by 3 Care Manager-delivered telephone
 MI/monitoring sessions; patients randomized to the Attention Control arm will have one brief
 session with their assigned Care Manager, followed by 3 Care Manager-delivered neutral
 telephone sessions
Inclusion Criteria:

 -  Current Male or Female patient at San Francisco VA Medical Center or affiliated VA
 clinics

 -  Must be older than 18 years

 -  Chronic musculoskeletal pain of at least 6 months duration and

 -  Prescribed one or more opioid pain medication for more than three months and

 -  Evidence of being a high-risk opioid user as determined by PI, electronic medical
 record, and study measures

 Exclusion Criteria:

 -  Non-English speakers

 -  Plans to relocate within 6 months; not able to come to San Francisco VA Medical Center
 for three in-person visits

 -  Cancer or other terminal illness involving palliative care with opioid medications

 -  Serious or untreated mental illness