Guiding Aging Long-Term Opioid Therapy Users Into Safer Use Patterns

Not Applicable

Completed

Conditions: Pain
Opioid Use

Interventions: Behavioral: PainTracker

Registration Number: NCT05808127

Lead Sponsor: University of Southern California

Brief Summary: Patients on long-term opioid therapy are aging and now face magnified risk of harm with continued high-dose opioid use. These increased risks are due to age-related changes in drug metabolism, multi-morbidity, and polypharmacy. The dominant approach to mitigate these risks is to screen for aberrant patient opioid behaviors so that clinicians can pre-empt misuse early through review of contractual opioid agreements or by lowering patient dosages. By focusing on opioid misuse alone, this strategy encourages forced opioid tapering that is associated with opioid overdose and mental health crisis. Directing clinician attention to the comorbid conditions associated with opioid misuse may promote safer and more effective care.

The objective of this study is to assess the comparative effectiveness of PainTracker, a set of questions that targets a broad range of problems associated with pain, in a randomized controlled trial involving 300 Northwestern Medicine clinicians treating Chronic Opioid Use Registry patients (n=5159).

Detailed Description: Using the electronic health record, patient portal, and patient-reported outcome capabilities, the investigators will develop programming logic for a randomized experimentation platform wherein two or more versions of pain surveys may be delivered to patients. This system will be used to evaluate PainTracker, delivered to half of the sample (approximately 2,579 patients). Clinicians treating Chronic Opioid Use Registry patients that meet the inclusion criteria will be assigned to one of two conditions involving patient surveys: 1) Current Opioid Misuse Measure \[COMM\] \[standard clinical care\] or 2) COMM + PainTracker. Surveys will be delivered monthly and patients will be prompted 3 times to complete the survey; once completed, patients will receive a score also delivered to their physician's inbox in Epic.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 286

Inclusion Criteria

• Patients age 65 or older on long-term opioid therapy within the Northwestern Medicine Chronic Opioid Use registry system with at least one primary care encounter in the past 12 months.

Exclusion criteria:

• Patient visits with active cancer diagnoses

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Current Opioid Misuse Measure (COMM) + PainTracker	PainTracker	On a monthly basis, patients will receive both the abbreviated Current Opioid Misuse Measure (COMM) and PainTracker. PainTracker tracks multiple outcomes relevant to the treatment of chronic pain: pain severity, general activity interference, enjoyment of life interference, sleep (initiating and maintaining), depression, and anxiety.

Primary Outcome Measures

Name	Time	Method
Referral rate to non-opioid care	9 months	Patient referral rate to non-opioid care that includes mental and behavioral health care, physical therapy, or sleep medicine referrals
Antidepressant orders	9 months	Rate of orders for antidepressant medications

Secondary Outcome Measures

Name	Time	Method
Clinician monthly milligram morphine equivalent (MME)	9 months	Clinician aggregate monthly milligram (mg) morphine equivalent (ME) for \>50 mg ME daily dose visits
Benzodiazepine prescribing	9 months	Clinician aggregate monthly milligram (mg) valium equivalent (VE) for \>50 mg VE daily dose visits