Project Summary Despite acknowledging the challenges of long-term opioid use (LTOT) in clinical and research studies, there is no consensus on clinically defining opioid misuse. In clinical practice, screening and risk/benefit calculations remain difficult because while opioid use can be problematic, it may be beneficial in certain subpopulations. The combination of variables that could be used clinically to assess the risk of harms versus quality of life for people on LTOT has not been established. It may be possible to decrease some of the tension between prescribers and patients if clinical providers have a working clinical definition and improved ways of assessing whether a patient is a candidate for LTOT. The MIRHIQL Resource Center's (MRC) long-term goal is to understand how chronic pain (CP) and related factors influence the progression of LTOT behaviors. The objective of MRC center is to create a research community that connects the MIRHIQL network to IMPOWR research centers and larger HEAL network to translate findings while developing a key opioid misuse and LTOT infrastructure. We hypothesize that defining opioid misuse and the LTOT benefit/risk framework will require integrated patient-centered clinical approaches that address the systemic issues affecting healthcare delivery and the patient-provider interaction, leading to a fundamental shift in how healthcare providers and the public are educated. These goals will be achieved through the following specific aims: (1) the MRC will harmonize data collection and common data elements for the MIRHIQL network, providing coordinated support for network activities while connecting to the IMPOWR Network and larger HEAL Ecosystem via our IMPOWR CC, (2) The MRC will clinically define opioid misuse with associated risks/benefits using an interconnected strategy including multi-society expert Delphi, qualitative interviewing of prescribers and people with lived pain experience, and phenotyping and validating cohort definitions in electronic health and administrative claims data, and (3) The MRC will perform analytical and clinical validation of screening and benefit/risk tools for LTOT and definition of opioid misuse in a cohort trial comparing different combinations of relevant OM variables. Usability (system/provider input) and user experience (provider/patient input) will evaluated for clinical utility in real-world clinical settings. These aims will provide a coordinated integration of systematic review, qualitative interviewing, EHR and claims data, and expert Delphi Taskforce to identify and test candidate variables for a clinical definition of opioid misuse and develop screening and risk/benefit tools for clinical care. The proposed research is innovative because we will be able to leverage the large-scale claims (CMS and private payer) and EHR data to build a framework for LTOT care on a rapid timeline. These results will support future research but will also have direct clinical impact, aligning with NIH HEAL's mission.

Project Narrative Public health is relevant to this project because although opioid medicines can be misused and abused, we are unclear about who might benefit from long-term opioid treatment. This project will combine existing knowledge and data with expert consensus to develop better ways to care for people living with chronic pain. This research aligns with NIH HEAL's goals to improve chronic pain care and decrease opioid misuse and abuse.