PROJECT SUMMARY / ABSTRACT The overarching goal of this 5-year K23 proposal is to support Taylor Crouch, PhD, in her development as an independent investigator in the overlapping areas of chronic pain and addiction, with a focus on enhancing uptake of evidence-based nonpharmacological chronic pain interventions and reducing reliance on long term opioid therapy (LTOT). Evidence-based behavioral interventions for pain are among the most effective and safe treatments, but utilization remains low, especially among patients on LTOT. The risks of LTOT, including opioid use disorder and overdoses, are well-established, but complex dependence can limit patients’ readiness to try something different. Two key barriers to uptake of nonpharmacological interventions have been identified as low motivation and logistical barriers to care. Two existing evidence-based interventions to enhance motivation and support behavior change, Motivational Interviewing (MI) and Contingency Management (CM), have promise for enhancing readiness to change among patients with chronic pain displaying risks on LTOT, and eHealth interventions can improve access and reach of interventions. Therefore, the objective of this proposal is to develop a MI/CM eHealth intervention to increase readiness to utilize nonpharmacological treatments and reduce reliance on opioids among individuals displaying risk on LTOT. Specific Aims are: Aim 1: To inform intervention approach, conduct exploratory testing with providers and patients to clarify needs/barriers, consolidate existing theory/evidence using the Medical Research Council framework, and complete initial testing of intervention ingredients. Aim 2: Develop an alpha prototype MI/CM eHealth intervention aimed at enhancing motivation to utilize nonpharmacological treatments and reduce opioid reliance, using the Computerized Intervention Authoring System, and assess usability. Aim 3: Develop beta and conduct a pilot randomized clinical trial to assess feasibility and acceptability. At the completion of the pilot trial in Aim 3, the intervention will be ready to be tested in an R01 to evaluate its efficacy in enhancing not only motivation, but action toward reduced opioid use and utilization of evidence- based non-opioid CP interventions. This proposal represents a 5-year comprehensive mentoring, training, and research plan to transition the candidate, Dr. Crouch, to a career as a successful independent investigator. Dr. Crouch has background training and expertise in behavior change, motivation, addictive behaviors, and behavioral chronic pain interventions, and through her comprehensive training plan she will be positioned to become a leader in these areas and further develop her expertise in implementation science and clinical trials.

PROJECT NARRATIVE The US is facing a “twin epidemic” with dual crises of chronic pain and opioid overdoses, and despite national efforts to reduce opioid prescribing and improve non-opioid pain management, opioid overdoses are increasing, including from prescription opioids, and uptake of evidence- based nonpharmacological pain treatment approaches remains low. More effectively treating pain with non-opioid strategies is key, but low motivation and logistical barriers have interfered with many patients transitioning from long term opioid therapy to other evidence-based treatments. The proposed study will aim to address both of these barriers by developing and evaluating a Motivational Interviewing (MI) and Contingency Management (CM) intervention aimed at increasing readiness to reduce opioid use and utilize non-opioid, evidence-based CP interventions among individuals displaying risk on LTOT.