This application proposes a mentored training program to develop Travis Lovejoy, PhD, MPH into an independent VA Health Services Research & Development (HSR&D) investigator with expertise in the treatment and study of pain in specialty substance use disorder (SUD) treatment settings. Dr. Lovejoy is a Clinical Psychologist and junior Health Services Researcher at the Portland VA Medical Center and Assistant Professor of Psychiatry at Oregon Health & Science University (OHSU). Dr. Lovejoy's training objectives for the Career Development Award (CDA) include (a) establishing further content expertise in pain and substance use disorders, (b) developing proficiency in the use of VA administrative data to answer key research questions, and (c) enhancing competency in qualitative and mixed methods approaches as they apply to clinical trials and implementation science. His training plan consists of formal coursework, advanced training workshops, and mentor-guided study. Dr. Lovejoy is supported by an accomplished mentoring team of health services researchers that includes Steven Dobscha, MD, Director of the Center to Improve Veteran Involvement in Care (CIVIC), the newly funded VA HSR&D Center of Innovation at Portland VA Medical Center; Linda Ganzini, MD, MPH, Associate Director of CIVIC and Professor of Psychiatry and Medicine at OHSU; Benjamin Morasco, PhD, CIVIC Research Investigator and Associate Professor of Psychiatry at OHSU; Dennis McCarty, PhD, Professor and Vice Chair of Public Health and Preventive Medicine at OHSU; and Hildi Hagedorn, PhD, Core Research Investigator at the Minneapolis VA Medical Center and Implementation Research Coordinator for the SUD Quality Enhancement Research Initiative (SUD QUERI). The resources at OHSU and the Portland VA Medical Center support the transition of junior researchers from mentored study to research independence. These resources, combined with the expert guidance of the mentoring team, will provide the ideal opportunity for Dr. Lovejoy to develop into an independent VA HSR&D investigator. Dr. Lovejoy will complete three interrelated studies during the CDA. Study 1 will use VA administrative data to characterize pain treatment utilization in a national sample of Veterans following initiation of specialty SUD treatment and compare pain treatment utilization to that of Veterans with co-occurring chronic pain and SUDs who do not initiate specialty SUD care. Findings from this study will inform a VA HSR&D Investigator Initiated Research proposal for a mixed methods study that will evaluate practices of high-and low- performing VA SUD treatment programs in managing Veterans' chronic pain. Study 2 will qualitatively examine pain treatment experiences and preferences in Veterans with chronic pain currently receiving specialty SUD treatment at a single VA Medical Center. Additional qualitative focus groups and interviews with key VA Medical Center stakeholders will examine barriers and facilitators to implementation of a collaborative pain intervention into a specialty SUD treatment setting. Data from study 2 will inform tailoring of an evidence- based, primary care-delivered collaborative pain intervention for implementation in a specialty outpatient SUD treatment setting. Study 3 is a pilot non-controlled trial of the tailored collaborative pain intervention delivered in the specialty SUD treatment setting. Findings from this pilot trial will inform a second VA HSR&D Investigator Initiated Research proposal for a multi-site effectiveness trial of the collaborative pain intervention that concurrently evaluates intervention implementation. Successful completion of the proposed research and training will prepare Dr. Lovejoy to become an independent VA HSR&D investigator with expertise in pain and substance use, clinical trials, and mixed methods research.

Public Health Relevance

Approximately 500,000 Veterans receiving care through VHA have one or more substance use disorders (SUDs), and a significant proportion of these Veterans experience chronic pain. Unfortunately, pain treatment as usual may ineffectively manage pain for these Veterans, and undertreated pain is associated with early dropout from specialized SUD treatment, continued substance abuse and relapse following completion of specialty SUD treatment, and poor long-term psychosocial functioning. Managing pain in Veterans with SUDs is critically important, yet little is known about current pain treatment practices within VA for Veterans with co- occurring chronic pain and SUDs, nor treatments that effectively manage pain and reduce substance abuse in this population. The proposed research addresses this current knowledge gap.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (IK2)
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HSR&D Career Development Award (CDA0)
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Portland VA Medical Center
United States
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Lovejoy, Travis I; Morasco, Benjamin J; Demidenko, Michael I et al. (2018) Clinician Referrals for Non-opioid Pain Care Following Discontinuation of Long-term Opioid Therapy Differ Based on Reasons for Discontinuation. J Gen Intern Med 33:24-30
Wyse PhD, MPP, Jessica J; Gordon MD, MPH, Adam J; Dobscha MD, Steven K et al. (2018) Medications for opioid use disorder in the Department of Veterans Affairs (VA) health care system: Historical perspective, lessons learned, and next steps. Subst Abus 39:139-144
Morasco, Benjamin J; Shull, Sarah E; Adams, Melissa H et al. (2018) Development of an Algorithm to Identify Cannabis Urine Drug Test Results within a Multi-Site Electronic Health Record System. J Med Syst 42:163
McPherson, Sterling; Lederhos Smith, Crystal; Dobscha, Steven K et al. (2018) Changes in pain intensity after discontinuation of long-term opioid therapy for chronic noncancer pain. Pain 159:2097-2104
Nugent, Shannon M; Dobscha, Steven K; Morasco, Benjamin J et al. (2017) Substance Use Disorder Treatment Following Clinician-Initiated Discontinuation of Long-Term Opioid Therapy Resulting from an Aberrant Urine Drug Test. J Gen Intern Med 32:1076-1082
Frank, Joseph W; Lovejoy, Travis I; Becker, William C et al. (2017) Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review. Ann Intern Med 167:181-191
Demidenko, Michael I; Dobscha, Steven K; Morasco, Benjamin J et al. (2017) Suicidal ideation and suicidal self-directed violence following clinician-initiated prescription opioid discontinuation among long-term opioid users. Gen Hosp Psychiatry 47:29-35
Lovejoy, Travis I; Morasco, Benjamin J; Demidenko, Michael I et al. (2017) Reasons for discontinuation of long-term opioid therapy in patients with and without substance use disorders. Pain 158:526-534
Feldstein Ewing, Sarah W; Lovejoy, Travis I; Choo, Esther K (2017) How Has Legal Recreational Cannabis Affected Adolescents in Your State? A Window of Opportunity. Am J Public Health 107:246-247
Lovejoy, Travis I; Dobscha, Steven K; Turk, Dennis C et al. (2016) Correlates of prescription opioid therapy in Veterans with chronic pain and history of substance use disorder. J Rehabil Res Dev 53:25-36

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