- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02272829
Behavioral Consultation for HIV+ Older Adults Prescribed Opioids for Chronic Pain (CHOACOT)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Up to 20% of HIV patients receive prescriptions for chronic opioid therapy (COT) to treat chronic pain. This project will develop a novel collaborative treatment, based on the primary care behavioral consultation model and behavior therapy techniques including motivational interviewing and functional assessment, in which a patient, a Behavioral Health Consultant and a HIV primary care provider share a unified plan targeting misuse of prescribed opioid analgesics in older HIV+ adults. This would be the first theoretically-driven, empirically-tested intervention that specifically attends to the difficult issues around chronic pain and opioid prescription in HIV clinical practice.
This project will develop a collaborative, brief, behavioral consultation intervention targeting misuse of prescribed opioids in older HIV+ adults. The intervention, CHOACOT (Consultation for HIV+ Older Adults on Chronic Opioid Therapy), will consist of:
- three meetings between the Behavioral Health Specialist (BHS) and the patient
- two brief consultations between the BHC and the HIV-PCP
- a joint meeting of the patient, BHC, and HIV-PCP.
To achieve our aims, we will develop CHOACOT beginning with an iterative open trial (n=10). Next, we will conduct a pilot randomized clinical trial (n=30) of CHOACOT versus enhanced Treatment-As-Usual. Opioid misuse will be the primary outcome variable. Quality of the patient-provider relationship, pain, problematic use of other substances, antiretroviral adherence, and psychosocial functioning will be secondary outcomes. The specific aims are:
Aim 1. Develop and refine CHOACOT so that it meets standards of feasibility and acceptability for HIV PCPs, BHCs, and participants;
1a. To develop and field test a CHOACOT BHC manual;
1b. To develop a reliable measure of BHC manual adherence;
1c. To develop and field-test BHC training and supervision procedures. Aim 2. Refine research procedures (e.g., consent and randomization processes, assessment procedures), and establish their feasibility and acceptability to participants while confirming recruitment goal targets.
Misuse of prescribed opioids is the primary outcome. Secondary outcomes are problematic use of substances with a high potential for lethality when used with COT (benzodiazepines, cocaine, alcohol, heroin), ARV adherence, viral load, pain, psychosocial functioning, patient-provider alliance, and treatment satisfaction and acceptability.
This line of work could lead to the incorporation into HIV care of a theoretically-driven and empirically-tested brief intervention for older HIV patients who are prescribed opioids for chronic pain and for whom there is concern about opioid misuse.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Rhode Island
-
Providence, Rhode Island, United States, 02906
- Butler Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- HIV patients with a physician at the enrollment site;
- Age 50 or older;
- Chronic pain (pain duration for at least six months);
- Daily use of an opioid analgesic, prescribed by an HIV-PCP at the study site, for at least the past 90 days;
- Patients endorse "feeling at risk of losing their pain medication prescription," or that they are "unhappy with how they and their doctors are working together to manage their pain";
- Patient-rated Addictions Behavior Checklist score > 3, as a recommended cut-point indicating opioid misuse.
Exclusion Criteria:
- Current, severe psychiatric symptoms requiring immediate clinical attention;
- Inability to understand English;
- Cognitive impairment severe enough to interfere with ability to actively participate in CHOACOT.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Active
Participants in this arm will receive the study intervention (sessions with the BHC and the PCP).
|
This is an intervention for individuals who use opioid medication for chronic pain, and targets the collaboration between the participant and his/her PCP.
|
Placebo Comparator: Health Education
Participants in this arm will receive study sessions about various health topics.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
opioid use
Time Frame: 4 months
|
opioid use will be assessed, through self-report measures, monthly over the course of the 4-month study participation period
|
4 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
quality of the patient-provider relationship
Time Frame: 4 months
|
quality of the patient-provider relationship will be assessed, through self-report measures, monthly over the course of the 4-month study participation period
|
4 months
|
pain
Time Frame: 4 months
|
pain will be assessed, through self-report measures, monthly over the course of the 4-month study participation period
|
4 months
|
problematic use of other substances
Time Frame: 4 months
|
problematic use of other substances will be assessed, through self-report measures, monthly over the course of the 4-month study participation period
|
4 months
|
antiretroviral adherence
Time Frame: 4 months
|
antiretroviral adherences will be assessed, through self-report measures, monthly over the course of the 4-month study participation period
|
4 months
|
psychosocial functioning
Time Frame: 4 months
|
psychosocial functioning will be assessed, through self-report measures, monthly over the course of the 4-month study participation period
|
4 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Michael Stein, MD, Butler Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Mental Disorders
- Chemically-Induced Disorders
- Substance-Related Disorders
- Pain
- Neurologic Manifestations
- Narcotic-Related Disorders
- Chronic Pain
- Opioid-Related Disorders
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Narcotics
- Analgesics, Opioid
Other Study ID Numbers
- DA038203
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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