A Research Agenda for Advancing Strategies to Improve Opioid Safety: Findings from a VHA State of the Art Conference
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Pain Research, Informatics, Multimorbidities & Education Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, USA; 2Yale School of Medicine, New Haven, CT, USA; 3Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA; 4University of Minnesota Medical School, Minneapolis, MN, USA; 5VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; 6Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; 7University of Washington School of Medicine, Seattle, WA, USA; 8Harvard Medical School, Boston, MA, USA; 9McLean Hospital, Belmont, MA, USA; 10Vulnerable Veteran Innovative Patient Aligned Care Team Initiative; Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; 11Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
US military Veterans have been disproportionately impacted by the US opioid overdose crisis. In the fall of 2019, the Veterans Health Administration (VHA) convened a state-ofthe-art (SOTA) conference to develop research priorities for advancing the science and clinical practice of opioid safety, including both use of opioid analgesics and managing opioid use disorder. We present the methods and consensus recommendations from the SOTA. A core group of researchers and VA clinical stakeholders defined three areas of focus for the SOTA: managing opioid use disorder, long-term opioid therapy for pain including consideration for opioid tapering, and treatment of co-occurring pain and substance use disorders. The SOTA participants divided into three workgroups and identified key questions and seminal studies related to those three areas of focus. The strongest recommendations included testing implementation strategies in the VHA for expanding access to medication treatment for opioid use disorder, testing collaborative tapering programs for patients prescribed long-term opioids, and larger trials of behavioral and exercise/ movement interventions for pain among patients with substance use disorders. J Gen Intern Med DOI: 10.1007/s11606-020-06260-9 © Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2020
INTRODUCTION
US military Veterans have been disproportionately impacted by the opioid overdose, morbidity, and mortality crisis, with a fatal overdose rate of 21.08 per 100,000 person years in 2016, a 65% increase from 2010.1 Prescribed opioids, opioid misuse, and opioid use disorder (OUD) contribute to substantial risk Received February 14, 2020 Accepted September 21, 2020
and negative impacts to individuals, including increased harms associated with other addictions, depression,2 sexual dysfunction,3 infectious disease transmission,4 and a plethora of other physical and mental co
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