In our NIDA-funded R34 pilot study of pain self-management training for prescription opioid taper support, we demonstrated that 22 weeks of opioid taper support promotes opioid dose reduction more effectively than usual care (43% vs 19% dose reduction from baseline) with no increase in pain intensity and significantly reduced activity interference. We now propose to adapt and test this intervention in a large integrated primary care system. To address patients’ fears of opioid taper that limited recruitment into our pilot study, we will begin with randomization to pain self-management training and then offer the option of self-paced opioid taper: Pain Self-Management Training for Opioid Taper (PSMOT). Specifically, we will test the effectiveness of this intervention, compared with usual care, on opioid dose and pain outcomes among patients on high dose (≥ 50 mg morphine equivalent dose) LtOT in a randomized controlled trial. This intervention will have 4 components: a) telephone-delivered evidence-based pain self-management training, b) web-based video of successfully tapered patients with motivational interviewing debriefing, c) a voluntary, self-paced opioid taper, and d) opioid and non-opioid prescribing guidance for the patient’s primary care provider. Specific Aim 1: To adapt our previously developed prescription opioid taper support intervention into a telephone-delivered pain self- management training that provides the option for supported opioid taper (PSMOT). This will be delivered in multiple primary care clinics by a nurse interventionist trained and supervised by a pain psychologist and will include guidance in opioid and non-opioid medication prescribing. Specific Aim 2: To test in a randomized trial the effects of this PSMOT intervention on: a) opioid outcomes: daily opioid dose (primary outcome), percent dose reduction from baseline, problem opioid use (interview, questionnaire, and electronic health record text indicators), and patient-reported opioid problems; and b) pain-related outcomes: PEG (self-report of Pain intensity, Enjoyment of life interference, General activity interference; primary outcome), pain self-efficacy, and depression symptoms. Hypotheses pertaining to opioid use: Patients receiving LtOT for CNCP randomized to the PSMOT intervention, as compared with those randomized to usual care, will have lower opioid doses, greater percent reduction of opioid dose, lower proportions with problem opioid use, and lower levels of patient-reported opioid-related problems at 6 and 12 months after randomization. Hypotheses pertaining to pain outcomes: Patients receiving LtOT for CNCP randomized to the PSMOT intervention, as compared with those randomized to usual care, will have lower PEG scores, higher levels of pain self-efficacy, and lower levels of depressive symptoms at 6 and 12 months after randomization. The proposed trial will determine whether pain self-management training can promote prescription opioid taper in higher-dose long-term opioid therapy patients without increasing pain levels or activity interference. If this trial is successful, then prescribers and patients may be able to pursue supported opioid taper without fear of escalating pain.

Project narrative The proposed trial will determine whether pain self-management training can promote prescription opioid taper in higher-dose long-term opioid therapy patients without increasing pain levels or activity interference. If the trial shows this, then prescribers and patients will be able to pursue supported opioid taper without fear of escalating pain. By offering an evidence-based path to reduce opioid exposure to patients, their families and communities, this research may provide important tools for combatting the opioid epidemic.