The use of chronic opioid therapy (COT) has increased dramatically in recent decades. More than 500,000 Veterans are treated with opioid pain medications in spite of inadequate evidence of long-term benefit and growing evidence of harm. Overdose deaths due to opioid medications are now the leading cause of adult injury death in the United States, surpassing motor vehicle accidents. The risk of overdose increases in a dose-dependent manner. It is therefore possible that opioid dose reduction, or opioid tapering, may prevent opioid-related adverse events without negatively impact pain or quality of life. To this end, the Opioid Safety Initiative promotes opioid dose reduction, or opioid tapering, in several high-risk scenarios and instructs VHA networks to establish “safe and effective tapering programs”. However, several important evidence gaps must first be addressed. First, Veterans’ perspectives on opioid tapering are not adequately understood. In our qualitative work, patients have described both barriers and facilitators of opioid tapering. Second, evidence- based, effective protocols to guide tapering are lacking, especially for the majority of patients who are prescribed COT in primary care settings. Third, patient outcomes in opioid tapering are not well characterized. Opioid tapering may both reduce risk and improve quality of life. As one patient in our qualitative work noted, “I got my life back.” Alternatively, opioid tapering may adversely impact pain, function and substance use. This proposal addresses these research gaps by adapting a collaborative care intervention to provide Veteran- centered, Veteran-driven opioid tapering support in VA primary care Aim 1: Describe the prevalence and correlates of Veterans’ desire to taper COT . We will measure patient- reported desire to taper COT and examine its association with patient engagement and other patient and medication characteristics. Aim 2: Adapt a collaborative care intervention to support opioid tapering in VA primary care. Building on an existing model, we will develop a team-based approach to deliver coordinated, longitudinal support of opioid tapering. The collaborative care team will use Motivational Interviewing to guide Veteran-centered goal setting to support behavior change. We will use the Nominal Group Technique to achieve stakeholder consensus. Aim 3: Conduct a single arm pilot feasibility study to support opioid tapering in a VA primary care setting. We will measure the intervention’s feasibility and acceptability and collect pilot data on patient-reported outcomes. This work is critically important to Veterans and VA healthcare systems nationally. It is well-aligned with the VA’s National Pain Management Strategy with its emphasis on primary care-based programs to promote Veteran-centered pain care. Four accomplished investigators will mentor the proposed research and the applicant’s development into an independent VA investigator. Dr. Cari Levy is the primary mentor...