Computer Based Treatment for Cognitive Behavioral Therapy and Cooperative Pain Education and Self-Management

Evaluate the efficacy of CBT4CBT-COPES versus standard care (treatment as usual) at 3 months (primary endpoint) among 160 individuals with OUD and chronic pain enrolled in OAT at the Liberation clinics. The primary outcome will be adherence to OAT (defined as continuous and verified enrollment at the 3-month timepoint); the primary pain outcome will be pain interference as measured by the PROMIS 6-item Pain Interference Short Form. Hypothesis 1a: Individuals randomized to CBT4CBT-COPES will have greater retention at the 3-month point than those assigned to standard care. Hypothesis 1b: CBT4CBT-COPES will be associated with greater reductions in pain interference at the 3-month point.

2. Conduct a 6-month follow-up to evaluate the durability of effects on the primary outcomes. The investigators hypothesizes CBT4CBT-COPES will be associated with greater adherence and reduced pain interference compared with standard care at the 3 and 6-month follow-ups (6 and 9 months post randomization).

Procedures Initial Screening by Project Manager or Research Assistant: Individuals enrolled in the buprenorphine or methadone programs at Liberation will be informed of the study via flyers, group meetings, or their clinicians. Individuals who indicate they are interested in hearing more about the study will be offered a meeting with the research staff. At the first interview, the research staff will provide an overview of the study and obtain written informed consent. The investigators use a multiple-choice test to assess participants' comprehension of the protocol, with ample time to review questions to assure understanding of the protocol, consent, and treatments offered. After determination of eligibility and informed consent, pre-treatment assessments will be completed. Randomization will occur as soon as participants have achieved a therapeutic dose of buprenorphine or methadone.

Urn randomization. To increase the likelihood that treatment groups are balanced with respect to demographic variables (gender, race), as well as likely prognostic variables (severity of opioid use disorder as moderate or severe via DSM-5 OUD symptom count, initial opioid experience of heroin versus prescription opioids, buprenorphine versus methadone treatment, pain severity (mild, moderate vs. severe) as operationalized by NRS average weekly pain rating). Participants will be assigned to treatment conditions through urn randomization using a Microsoft Access program developed and implemented successfully in multiple previous trials.

Treatment phase: Treatment conditions are described in detail below. Study treatments will last 12 weeks. During the treatment phase, all participants will meet weekly with the research assistant for completion of self-report and interview assessments preferably in-person, but with the option of virtual meetings. Breath and urine sample collection will be taken by the research assistant at this time.