# Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS) Trial

> **NIH NIH R33** · UNIVERSITY OF SOUTHERN CALIFORNIA · 2021 · $602,800

## Abstract

ABSTRACT
There is a lack of evidence that long-term opioid use offers benefit for noncancer pain and an
abundance of evidence of harm​. Last year, the Centers for Disease Control and Prevention
(CDC) issued the “CDC Guideline for Prescribing Opioids for Chronic Pain” to encourage safe
and effective alternatives to opioids, discontinuation of opioids when patients do not resume
normal activities and prudent dosing strategies. However, poor guideline adherence is a general
concern and may impede uptake. ​Our prior studies have used insights from behavioral
economics and social psychology to increase guideline adherence. We propose to apply these
techniques within the Application of Economics & Social psychology to improve Opioid
Prescribing Safety (AESOPS) Trial to improve adherence to the CDC and to the Oregon Pain
Guidance pain management guideline. In the R21 phase, we will assess the feasibility of
implementing the following candidate nudges: 1) Defaults (guideline concordant actions that
take place when clinicians fail to act), 2) precommitments (advanced commitments by clinicians
to guideline adherent behaviors that bind them to these behaviors in the future), 3) justifications
(free-text responses entered by the clinician that explain why guidelines were not followed and
which are recorded as a patient note in the electronic health record); these are triggered when
defaults are removed and commitments are not honored, 4) peer comparisons (a type of
socially motivated performance reporting) and 5) a nudge to increase the salience and
availability of adverse opioid events. In the R33 phase, we will conduct the AESOPS trial, an
18-month cluster randomized trial. The trial is across 374 primary care clinics in the U.S. We
compare three conditions: C1) Peer comparison and justification , C2) defaults, precommitments
or available adverse events added to the C1 interventions, C3) education control. The primary
outcomes is clinician aggregate monthly mg morphine equivalent (ME) for patients with ​>​50 mg
ME daily dose. Secondary, outcomes are benzodiazepine co-prescribing and rate of dose
escalation to ​>​50 mg ME/day. We anticipate that the AESOPS trial will provide new knowledge
about how to improve adherence to the CDC Guideline for Prescribing Opioids for Chronic Pain
and to concordant pain guidelines. The trial may also help us understand how to prevent future
incidents of opioid use disorder and opioid poisoning death by lowering unnecessary population
exposure to these drugs.

## Key facts

- **NIH application ID:** 10249262
- **Project number:** 5R33AG057395-05
- **Recipient organization:** UNIVERSITY OF SOUTHERN CALIFORNIA
- **Principal Investigator:** JASON N. DOCTOR
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $602,800
- **Award type:** 5
- **Project period:** 2017-09-15 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10249262

## Citation

> US National Institutes of Health, RePORTER application 10249262, Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS) Trial (5R33AG057395-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10249262. Licensed CC0.

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