# Examining the Consequences of Reductions in Opioid Prescribing on Patients, Clinical Care, and Community Health

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $529,883

## Abstract

We propose to use qualitative methods to examine the consequences of reductions in opioid prescribing for
chronic non-cancer pain (CNCP) on patients, clinical care delivery, and community health. Over 80 million
Americans report CNCP, defined as non-malignant pain that lasts longer than three months, not associated with
end of life. Escalations in opioid prescribing for CNCP over the past two decades have been associated with
dramatic increases in opioid-associated morbidity and mortality. In response, the Centers for Disease Control
and Prevention, the American Pain Society, and the American Medical Association developed
recommendations to limit reliance on opioids, by encouraging clinicians to (1) consult statewide prescription
drug monitoring programs when prescribing opioids; (2) not initiate opioid therapy for CNCP; and (3) monitor,
taper, and/or discontinue opioids in CNCP patients. These recommendations are being implemented
nationwide and evidence suggests a concomitant decrease in the total number of opioid prescriptions. Yet, little
data exist documenting the long term consequences, positive or negative, of reductions in opioid prescribing.
The proposed study builds on our previous R01 (DA034625), Pain Management in the Clinic and Community
(PMCC), that examined the management of CNCP in patients with a history of substance use who received pain
care in safety net clinical settings. Medicaid insured patients with a CNCP diagnosis are more likely than their
privately insured counterparts with CNCP to receive opioid prescriptions. Patients with a history of substance
use are more likely to receive a diagnosis of CNCP, to be prescribed opioids, and to transition to chronic opioid
therapy than patients without substance use histories. The proposed study will use the social-ecological model
of health to address the following specific aims: (SA1) To examine the consequences of reductions in opioid
prescribing on patients' experiences of CNCP; (SA2) To examine the consequences of reductions in opioid
prescribing on patient-clinician relationships and clinical care delivery in primary care safety net settings; (SA3)
To examine the consequences of reductions in opioid prescribing from the perspectives of community
stakeholders. The proposed longitudinal study will take place in four safety-net clinics and patients'
home/community environments in two diverse San Francisco Bay Area Counties. We will conduct qualitative
enrollment and follow-up interviews with 30 primary care clinicians and 60 of their CNCP patients with a history
of substance use, and clinical observations between clinicians and matched patients (SA1&2). We will
theoretically sample 30 of the 60 CNCP patients and conduct ethnography in patients' home environments, and
interview 40 community stakeholders (SA1&3). The multidisciplinary research team, consisting of a medical
anthropologist, a physician investigator who studies opioid misuse and practices in the safety net, and a
nurs...

## Key facts

- **NIH application ID:** 9873009
- **Project number:** 5R01DA043631-04
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Kelly Ray Knight
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $529,883
- **Award type:** 5
- **Project period:** 2017-05-01 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9873009

## Citation

> US National Institutes of Health, RePORTER application 9873009, Examining the Consequences of Reductions in Opioid Prescribing on Patients, Clinical Care, and Community Health (5R01DA043631-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9873009. Licensed CC0.

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