The study establishes a prescription opioid registry using EHR dispensation data from 2012-2017 across 10 health systems to identify algorithms and data elements that will be harmonized in a distributed data architecture. The registry will be used in the following aims.
A. examine opioid use patterns over 2012-2017 to examine changes during the evolving prescribing environment. We will examine differences in rates by age, gender, and race/ethnicity.
B. examine categories of tapering (e.g. decreased opioid use) among prescription opioid patients, and whether faster taper rates are associated with adverse events (e.g. overdose, mortality).
C. examine if patients with SUD or psychiatric conditions are less like to taper opioid use, compared to patients without those conditions.
D. examine how dispensations post-surgery and for acute pain are related to subsequent long term opioid use and opioid dosage levels, which are risk factors for OUD and overdose.
Phase 2. analysis to identify different measures of buprenorphine retention, and explore the methods needed to examine the association to mortality rates.

A cluster-randomized trial, conducted in 5 primary care sites, with 100 PCPs and 300adult primary care patients, will test the efficacy of STOP versus enhanced usual care (EUC). The STOP intervention, if proven efficacious, will provide a solution to preventing OUD among patients who are most at risk, thus addressing a key aspect of the current opioid crisis

This study is a one group, cross-sectional survey study. Active buprenorphine (BUP) prescribers will be recruited to participate in an online survey of clinical program features, characteristics of patients with opioid use disorder (OUD), patients’ experience with precipitated withdrawal during BUP induction, and patients’ fentanyl use at a single time point. Millennium Health (MH) will provide urine drug test (UDT) results from the counties of prescribers who participated in the survey. Both the survey and UDT results will be obtained from addiction treatment clinics. The UDT results and survey data will be merged at the county level to assess the association between precipitated withdrawal issues and fentanyl, fentanyl analogues, and other drugs of abuse.