The United States faces an opioid crisis with an associated epidemic rate of death from opioid overdose. Although use and misuse of opioids has occurred for centuries, changes over the past 20 years have contributed to dramatic increases in the morbidity and mortality associated with these agents. The current crisis began with prescription opioids being used and overused for pain, followed by increases in heroin use and associated mortality, and most recently a shift to the use of synthetic opioids such as fentanyl. Successfully reducing the rates of opioid use disorder and overdose will require engaging front-line clinicians and providing them with the information and skills that will allow them both to manage pain more safely while avoiding over-use of opioids and also to build their capacity to diagnose and treat patients with opioid-use disorder using evidence-based approaches. Our multidisciplinary project team will evaluate the impact of clinician-directed interventions on opioid prescribing and overdose-related outcomes. The research proposal is paired with ongoing CDC-supported interventions by the Oregon Health Authority (OHA) and with a proposal from OHA for additional CDC funding to continue and expand those efforts over the next three years. The OHA interventions will combine academic detailing (AD) and the Six Building Blocks practice facilitation (PF) approach to support practices in making changes. Implementation will occur across the Oregon Rural Practice-based Research Network, supplemented by other practices in Oregon, and will involve a minimum of 100 practice sites. Our project team includes the original developers of both AD and the Six Building Blocks approach, which will ensure the quality of implementation and relevance of the evaluation. We will evaluate the fidelity of implementation of AD and PF and the impact on practices? and providers? knowledge, attitude, and behaviors regarding opioid prescribing and opioid use disorder treatment. We will build on existing work to create a linked dataset for analysis, combining information from the state prescription drug monitoring program, all-payer claims database, emergency response system, vital records, hospitalization data, and substance-use disorder treatment system. These unique data tools will allow for a mixed methods analysis that will provide insights into both the processes and outcomes of adapting these interventions for the opioid crisis. We will further test the potential adaptation of the linked data set into a common data model format, creating opportunities for cross-state research on opioid interventions in the future. Research findings will be rapidly translated and disseminated through multiple channels such as presentations at conferences and publication of research articles. The proposal PI directs the National Resource Center for Academic Detailing, identified in the RFA as an important source for information, support, and technical assistance, and this platform will enhance translation to a broader national audience.
Interventions to address the opioid crisis and reduce the rate of overdose will require engaging front- line clinicians to help them both treat pain more safely without overusing opioids and increase the use of treatments for opioid use disorder. This proposal builds on an existing collaboration between a leading implementation research team and the Oregon Health Authority Public Health Division. We will rigorously evaluate clinician-facing interventions implemented over the next 3 years, assessing their impact on clinicians? knowledge and behavior and how those changes are reflected in opioid prescriptions, engagement of patients in treatment for opioid use disorder, and reduced harms from overdoses.
