# Long-Term Opioid Therapy: Screen to Evaluate and Treat (Opioid-SET)

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2020 · —

## Abstract

Background: Despite high numbers of VHA patients (>300,000) receiving long-term opioid therapy (LTOT),
evidence of its harms is growing (e.g., inadequate pain control, side effects, overdoses). Although VA/DoD
Guidelines recommend frequent, multi-component monitoring of LTOT patients, monitoring is under-utilized
because it does not fit with primary care’s workflow. In addition, rates of opioid discontinuation are increasing,
even though discontinuation is often harmful (e.g., more use of street heroin, worsening mental health).
Further, for patients for whom both continued LTOT and tapering for discontinuation are determined to be
potentially harmful, a clinical practice guideline (CPG) is not available, leaving them “guideline-orphaned.”
Significance: With increasing opioid overdose deaths and complications of LTOT due to comorbidities, policy
emphases have shifted to reducing opioid prescribing, and monitoring and discontinuing opioids among LTOT
patients. This project will help providers maintain high-quality patient care while responding to policy shifts. It
addresses the VHA’s and HSR&D’s goal of offering patient-centered care by giving providers an integrated
instrument to reduce harms due to LTOT continuation and discontinuation, which are widespread and severe
among Veterans. Innovation: This project has the potential to change LTOT practices by giving primary care
and other providers new, easy-to-use screening tools that will facilitate adherence to recommended guidelines
on monitoring of LTOT patients, and discontinuation of LTOT when it is harmful. The integrated instrument may
be incorporated into CPRS to facilitate its use in VA health care clinics. The project will also change practice by
providing new, provisional guidelines for a challenging group of LTOT patients for whom CPGs do not exist.
The work to be accomplished is complementary to VHA initiatives by contributing to components of best
practices for balancing pain management and opioid prescribing, “S.T.O.P. P.A.I.N,” i.e., Stepped care model;
Treatment alternatives; Ongoing monitoring of usage; and Practice guidelines. Specific Aims are to develop an
integrated instrument with two screening tools, the first to indicate if LTOT is harmful to continue (yes or no;
Aim 1), and the second to indicate if tapering to discontinue opioids is harmful to initiate (yes or no; Aim 2).
Positive screens will indicate that providers should undertake additional, more comprehensive monitoring and
examination to determine the harm of continued LTOT or tapering to discontinuation, respectively. Aim 3:
Inform subsequent CPGs by determining preliminary treatment approaches for “guideline-orphaned” LTOT
patients. Methods to develop the tools will involve (1) comprehensive literature searches to yield an initial item
bank for each screening tool; (2) qualitative item analyses using focus groups with patients and providers,
cognitive interviewing with patients, expert review, and item revision to ...

## Key facts

- **NIH application ID:** 9951608
- **Project number:** 1I01HX002833-01A2
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** Katherine JoAnn Hoggatt
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-09-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9951608

## Citation

> US National Institutes of Health, RePORTER application 9951608, Long-Term Opioid Therapy: Screen to Evaluate and Treat (Opioid-SET) (1I01HX002833-01A2). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9951608. Licensed CC0.

---

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