# Diagnosing and Treating Veterans with Chronic Pain and Opioid Misuse

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background: As many as 30% of the ~10 million Americans prescribed long-term opioid therapy (LTOT) are
estimated to misuse opioids. Receiving LTOT is associated with opioid-related harms, and misuse leads to an
increase in the dose consumed and other risky behavior, further worsening outcomes. However, there is a gap
in knowledge on how to identify and treat this patient population particularly when they do not meet diagnostic
criteria to be treated by medications for Opioid Use Disorder (OUD). In recent years, guidelines from the
Centers for Disease Control and the Veterans Health Administration (VHA) have effected widespread tapering
to reduce misuse. Buprenorphine, a medication used for both pain and OUD, may also be effective in reducing
opioid-related harms while controlling pain for patients on LTOT with misuse; however, buprenorphine is yet to
be tested rigorously in this patient population. Therefore, studies are needed to identify patients on LTOT with
misuse and to compare the efficacy of different treatments on patient outcomes.
Significance: Chronic pain, LTOT for pain, and opioid misuse are common among Veterans and lead to
multiple health-related harms. The VHA has made improving pain care and reducing opioid harms a major
priority of clinical initiatives, and this proposal responds to the Health Services Research and Development
(HSR&D) Funding Announcement #HX-21-024 to address those opioid-related priorities. By filling a crucial
evidence gap, this proposal will significantly impact the way we treat pain and minimize harm for Veterans with
opioid misuse.
Innovation and Impact: This proposal is innovative and impactful in many ways. First, this project will utilize the
unique capabilities of the VHA’s Corporate Data Warehouse (CDW) to develop a novel algorithm to identify
patients on LTOT with misuse. If successful, this automated identification process has the potential to be
scaled to VHA sites across the country. Second, the comparative effectiveness of different treatments will be
determined by an emulated trial, an innovative and efficient study design that can lead to greater
generalizability than standard trials, which suffer significantly from selection bias in this area. The treatments
being evaluated in the emulated trial are readily available, so if specific treatments are found to improve patient
symptoms and reduce adverse outcomes, it will be feasible for Veterans with opioid misuse to access these
treatments nationwide. Finally, we will gather feedback from providers and Veterans to understand the best
strategies and interventions to scale the identification process and better inform Veterans and providers of
evidence-based treatment options.
Specific Aims: This project aims to 1) Classify a cohort of patients on LTOT with opioid misuse but without
OUD by a) building on a previously developed augmented chart review methodology and b) applying an
algorithm to structured data; 2) Conduct an emulated trial to compare t...

## Key facts

- **NIH application ID:** 10759402
- **Project number:** 5I01HX003411-03
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Amy S B Bohnert
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-01-01 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10759402

## Citation

> US National Institutes of Health, RePORTER application 10759402, Diagnosing and Treating Veterans with Chronic Pain and Opioid Misuse (5I01HX003411-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10759402. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*