Opioid Misuse Mitigation and Practice Quality Improvement in Primary Care

We plan to conduct a controlled trial with chronic pain patients who have been or will be prescribed opioids in primary care centers. Our focus is on drug misuse behaviors that can be monitored by a treating primary care physician that can signal potential problems. The goal of tracking and changing these behaviors is to improve compliance with opioids and reduce opioid misuse. We will develop and pilot-test a unique intervention for patients with chronic noncancer pain who show risk for or evidence of misuse of prescription opioids. A pain treatment protocol will incorporate reliable and validated screening questionnaires and tools developed at our center to accurately identify Opioid medication misuse (Screener and Opioid Assessment for Pain Patients Revised, SOAPP-R; Current Opioid Misuse Measure, COMM; Pain Assessment Interview Network and Clinical Advisory System; painCAS). We intend to evaluate opioid use and changes in quality of life of patients in two types of primary care centers. This study will help determine whether primary care physician (PCP) education, careful monitoring, and incorporation of a structured opioid therapy protocol (routine urine screens, opioid agreements and compliance checklists) will improve compliance with prescription opioids and reduce opioid misuse. We intend to determine the clinical benefit of 1) electronic pain assessment programs, 2) increased communication strategies between pain specialists and primary care physicians and 3) education and use of practice guidelines to improve pain management within a busy primary care center. The results of this study will hopefully lend insight into the best pain medicine practice models for primary care physicians.