Opioid Use

Title: Variation in Home Opioid Consumption after Total Knee Replacement: Investigating the Role of Pain Sensitivity and Gene Expression

Funded by the National Institute on Nursing Research (K23NR020512), PI: Schirle, Vanderbilt University

Prolonged opioid use after surgery is one of the most common but least understood surgical complications. Little is known about why some people take relatively few opioids, while others go on to consume opioids long after the expected postoperative pain course. This project will examine potential factors, including pain sensitivity and transcriptomic influences on the variation in postoperative pain and opioid use after total knee replacement, a surgery demonstrating great variation in opioid use.


Title: Stress and Opioid Misuse Risk: The Role of Endogenous Opioid and Endocannabinoid Mechanisms

Funded by the National Institute on Drug Abuse (R01DA050334), PI: Bruehl, Vanderbilt University Medical Center

Elevated stress is known to enhance risk for opioid use disorder (OUD), a significant problem given the frequent use of opioid analgesics in chronic pain management.  This project targeting patients with chronic low back pain will test an innovative model in which low endogenous opioid (EO) and endocannabinoid (EC) activity associated with elevated stress both contribute to increased OUD risk via their association with heightened reinforcing effects of opioids (e.g., drug liking).  Results will provide important new mechanistic understanding of how stress increases OUD risk, and may identify a novel and clinically-pragmatic marker of risk-enhancing differential opioid responding.


Title: Integrated Health Services to Reduce Opioid Use While Managing Chronic Pain

Funded by the Patient-Centered Outcomes Research Institute (PCORI), PI: McCormack, RTI International, Site PI: Archer, Vanderbilt University Medical Center

Recently declared a public health emergency, opioids have claimed the lives of over half a million people between 2000 to 2015. Every day an average of 91 Americans die from an opioid overdose. One of the driving forces of this epidemic has been the use of prescription opioids for chronic pain. However the effectiveness of opioid therapy is unclear and exposes patients to potential risks, including addiction. Safer treatment options for long term management of chronic pain are needed.

This pragmatic trial is a collaboration between RTI International, Vanderbilt University Medical Center, University of North Carolina, and Duke University. Dr. Archer is the site PI for the Vanderbilt site. This trial will help patients better understand the risks, benefits, and uncertainties associated with opioid use and will receive other treatment options for managing their pain. Patients on chronic opioid therapy seen in primary care or pain clinics will be randomized to guideline-concordant pharmacotherapy with shared decision making (Arm 1) or guideline-concordant pharmacotherapy with motivational interviewing (MI) and cognitive behavioral therapy (Arm 2). (https://clinicaltrials.gov/ct2/show/NCT03454555)