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.

Study aims are to: Aim 1: Conduct a survey of licensed community pharmacists to study their knowledge of, attitudes about, and intention to provide patient care and services for SRT and MOUD; and Aim 2: Conduct a qualitative interview of a sample of up to 50 survey participants (range: 20 to 50 participants) from Aim 1 to further assess survey participants’ interest in implementing preventive care services for SUDs and medication therapy management for patients with opioid use disorder (OUD) in their practice. Together, the results will inform pharmacy-based study designs and future directions for the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN) studies as well as training and educational needs for community pharmacists.

When a patient is at elevated risk of suicide, the PCC will be prompted by Opioid Wizard to complete the Columbia-Suicide Severity Risk Scale (CSSRS), easily available to all PCCs in the EHR and saved as discrete data elements. Risk-based (depending on CSSRS score) referral and follow-up recommendations for suicide prevention will be given, with specific care recommendations ranging from care as usual (very low risk) to referral to behavioral health for evaluation and safety planning (moderate to high risk) to immediate evaluation in the emergency department and potential inpatient admission (very high risk), building on workflows developed for use by care managers in in our recently completed suicide prevention trial of over 19,000 people at elevated risk of suicide.

This project seeks to compare the relative effectiveness of using social media sites versus informational sites like to promote HIV self-testing and PrEP uptake. MSM between 18-30 years old will receive culturally-relevant advertisements targeting minorities similar to those previously developed. Specifically, the study aims to 1) adapt existing social media-based HIV self-testing and PrEP advertising materials for digital distribution on social media and informational sites and 2) compare the effectiveness of HIV testing and PrEP uptake promotion across social media sites versus online informational platforms.