Enhancing the impact of behavioral pain management on MAT outcomes

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Project Summary/Abstract In order to address the opioid epidemic in the United States, it is essential to improve outcomes in individuals with opioid use disorders (OUD). Medication Assisted Treatments (MAT) can be extremely helpful for those with OUDs but poor treatment retention on MAT diminishes the potential positive impact of these interventions. One factor that has been linked to poorer outcomes in those with OUD and may undermine treatment adherence is chronic pain, which is reported in the majority of those receiving OUD treatment. Psychosocial interventions for pain have been effective in patients with chronic pain and substance use disorders, but these interventions have not been thoroughly examined in the OUD population receiving MAT. The study team received a recent grant from the National Center for Complementary and Integrative Health to refine and adapt a psychosocial pain management intervention (PPMI) to be delivered by telephone for patients with OUD receiving MAT. After finalizing the intervention this funded study will conduct a randomized trial (N=100) comparing telephone-based PPMI approach to EUC to assess the impact of randomization to PPMI on MAT retention, pain level, pain-related functioning, and frequency of opioid use. However, more work is needed to understand the potential applicability of this intervention to other high-risk groups, study the longer-term impact of PPMI and gather data to inform the implementation of PPMI in MAT patients. In particular, understanding methods to reach Veterans is important because of consistent evidence highlighting the high prevalence of OUDs and opioid-related adverse events, including overdose, in Veterans. The proposed work addresses the gaps in the literature and builds on the ongoing, funded project by: (aim 1) adding additional recruitment sites at the VA Ann Arbor Healthcare System (100 additional participants or a total N of 200 when combined with the ongoing study); (aim 2) extending the measurement of longer-term outcomes by adding follow-up assessments at 6-, 9- and 12-months for the entire sample (N=200); (aim 3) facilitating the rapid implementation of results by gathering qualitative data from key stakeholders including MAT treatment providers (N=15) and patients who received the PPMI intervention (N=20 participants recruited at the end of the trial). This work will provide a robust test of the PPMI intervention to help enhance MAT outcomes in a larger and more-representative group of participants while also paving the way for future implementation of interventions to improve MAT retention.