# Development and pilot testing of LIMIT: a multicomponent tool to support opioid tapering

> **NIH VA I01** · VA CONNECTICUT HEALTHCARE SYSTEM · 2020 · —

## Abstract

The number of veterans receiving opioids from VHA providers increased from 651,000 in 2001 to 1,101,346 in
2013, with a substantial proportion receiving long-term opioid therapy (LTOT). Rising concerns regarding
modest or absent benefit with LTOT as well as significant short- and long-term side effects have resulted in
widespread efforts to curtail the use of opioids in the VHA. However, resources to support veterans who wish
to taper are inadequate. Primary care, where most LTOT in VHA is prescribed, is overburdened and straining
to meet the challenge of caring for patients with chronic pain. Pharmacist-run and other resource intensive
clinical programs are effective, but may be too time or resource intensive to be feasible for many facilities.
Furthermore, even well-resourced hub medical centers typically struggle to meet the needs of community-
based outpatient clinics. A scalable, relatively inexpensive tapering intervention to support primary care and/or
to extend the reach of resource-intensive specialty clinics would be of great benefit to veterans who are not
deriving sufficient benefit from LTOT.
As such, the goal of this proposal is to develop LIMIT (Less Is More In Opioid Treatment), an interactive,
theory-informed, multi-component mobile website program to enable veterans to safely taper opioids. We will
develop LIMIT using the Intervention Mapping (IM) framework, a rigorous protocol for developing effective
behavior change interventions. To meet our objective, we propose the following specific aims:
Aim 1. To develop LIMIT following the first four iterative steps of the IM protocol. We will develop a
functional prototype based on the data generated from a needs assessment, change objectives, and
proposed theory-based behavior change techniques. Key informants (including veterans and primary
care providers) have and will continue to will be involved in the development of LIMIT to enhance
usability, future dissemination and implementation.
Aim 2. To pre-test the initial LIMIT prototype. We will perform iterative rounds of usability testing of the
LIMIT prototype with four to six veterans on LTOT per round and then field test the refined mobile website
program in a real-world setting. Usability will be tested using both qualitative and quantitative approaches and
refinements will be made as required.
Aim 3. To evaluate feasibility of a full-scale efficacy RCT of LIMIT. We will conduct a 9-month,
randomized, two-arm, parallel, open-label, feasibility trial. Eligible participants will be randomized to LIMIT
versus a pain monitoring app. Outcome measures will be collected over 9 months.
To ensure rigor and successful future implementation, we will: 1) develop an evidence based program with
features proven to maximize engagement and retention; 2) ensure that the program includes mechanisms to
address the diverse obstacles veterans report when consider opioid tapering (e.g. fear of pain flares and
abandonment by the system); 3) employ a User...

## Key facts

- **NIH application ID:** 9838671
- **Project number:** 5I01HX002509-02
- **Recipient organization:** VA CONNECTICUT HEALTHCARE SYSTEM
- **Principal Investigator:** WILLIAM C BECKER
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-12-01 → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9838671

## Citation

> US National Institutes of Health, RePORTER application 9838671, Development and pilot testing of LIMIT: a multicomponent tool to support opioid tapering (5I01HX002509-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9838671. Licensed CC0.

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