# Integrating Tailored Postoperative Opioid Tapering and Pain Management Support for Patients on Long-Term Opioid Use Presenting for Spine Surgery (MIRHIQL)

> **NIH NIH R01** · STANFORD UNIVERSITY · 2023 · $3,406,550

## Abstract

Abstract
51 million Americans undergo surgery annually and 10-20% present for surgery with long-term opioid use
(LTOU) far exceeding the national prevalence. These patients on LTOU are at overwhelmingly increased risk
of postoperative complications, morbidity, mortality, increased pain, persistent postoperative LTOU, and opioid-
related harms. Surgery is a critical point-of-care for patients with LTOU as opioids are prescribed regardless of
prior problematic opioid use, opioids are acutely escalated for prolonged durations compounded opioid-related
harms, and patients are at heightened risk for a myriad of negative postoperative outcomes adversely
impacting QOL. Research examining postoperative opioid tapering and non-opioid acute pain management
often excludes these vulnerable patients. Our proposal addresses this critical knowledge gap in acute to
chronic postoperative pain care for patients with LTOU. Patients are receptive to changes in pain therapy and
opioid tapering after surgery, representing a key intervention opportunity. Also, safer alternatives are needed to
reduce serious risks of respiratory depression associated with concomitant use of certain common non-opioid
and opioid pain medications. This proposal builds off the PI’s research (K23, R01) developing postoperative
Motivational Interviewing and guided Opioid Tapering support (MI-Opioid Taper) and demonstrating feasibility
and initial empiric support in promoting postoperative opioid cessation without adversely affecting pain even
among patients with preoperative opioid use. Tizanidine has analgesic, muscle relaxant, anxiolytic and opioid-
sparing effects, and potential to relieve opioid withdrawal symptoms as an 2-agonist. We directly address the
HEAL MIRHIQL initiative by examining the combined effects of MI-Opioid Taper (behavioral) and tizanidine
(pharmacologic) interventions among patients with preoperative LTOU exhibiting impaired return to baseline
opioid use after surgery where harms may outweigh benefits of continued use. In this Type 1 hybrid
effectiveness-implementation three-arm parallel RCT, 375 patients with preoperative LTOU undergoing spine
surgery will be recruited across 4 sites (Stanford, Harvard, Wake Forest, U. of Kansas) and randomized to 1 of
3 groups (MI-Opioid Taper and tizanidine, MI-Opioid Taper and placebo, enhanced usual care) and followed
for 12 months. The primary outcome is time to baseline opioid use. Secondary outcomes are time to opioid
cessation, opioid dispensing cessation, pain cessation, and risk of postoperative opioid misuse. We will
examine motivation for change, change talk, and reduction in pain as mediators of treatment effects and
characterize treatment interactions with participant attributes in predicting both treatment engagement and
efficacy. A mixed-methods evaluation using the RE-AIM framework will explore barriers and facilitators to
future larger-scale implementation of MI-Opioid Taper. The project will address the unmet needs...

## Key facts

- **NIH application ID:** 10722943
- **Project number:** 1R01DA058694-01
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** Jennifer Hah
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $3,406,550
- **Award type:** 1
- **Project period:** 2023-08-15 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10722943

## Citation

> US National Institutes of Health, RePORTER application 10722943, Integrating Tailored Postoperative Opioid Tapering and Pain Management Support for Patients on Long-Term Opioid Use Presenting for Spine Surgery (MIRHIQL) (1R01DA058694-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10722943. Licensed CC0.

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