Improving Opioid Safety in Veterans Using Collaborative Care and Decision Support

The investigators will develop and test the acceptability, feasibility, and preliminary
efficacy of a Collaborative Care intervention in which one of two Care Managers delivering
both interventions will assist primary care providers (PCPs) by using Motivational
Interviewing to communicate computer-based ATHENA-OT (opioid therapy) decision support
guidelines to veterans with chronic pain. Specifically, after honing the intervention, the
investigators will conduct a pilot randomized controlled trial of Collaborative
Care/Motivational Interviewing in 100 veterans (ages 18 and older) with chronic pain in
primary care who are prescribed opioid pain medications and exhibit at least one "high-risk"
opioid use behavior (e.g. obtaining early opioid refills, etc.). Using ATHENA-OT decision
support, PCPs will make guideline-concordant recommendations to all enrolled study patients
and initiate a Pain Care Plan. Veterans randomized to Collaborative Care, will have one MI
session with their assigned study Care Manager followed by 3 Care Manager-delivered
telephone MI/monitoring sessions; patients randomized to the Attention Control arm will have
one brief session with their assigned Care Manager, followed by 3 Care Manager-delivered
neutral telephone sessions

Inclusion Criteria:

- Current Male or Female patient at San Francisco VA Medical Center or affiliated VA
clinics

- Must be older than 18 years

- Chronic musculoskeletal pain of at least 6 months duration and

- Prescribed one or more opioid pain medication for more than three months and

- Evidence of being a high-risk opioid user as determined by PI, electronic medical
record, and study measures

Exclusion Criteria:

- Non-English speakers

- Plans to relocate within 6 months; not able to come to San Francisco VA Medical
Center for three in-person visits

- Cancer or other terminal illness involving palliative care with opioid medications

- Serious or untreated mental illness