# Psychological Risk Factors for Persistent Opioid Use and Prevention of Chronic Opioid Use and Misuse After Surgery: Postoperative Motivational Interviewing and Guided Opioid Weaning

> **NIH NIH R01** · STANFORD UNIVERSITY · 2020 · $503,485

## Abstract

Abstract
This project addresses areas of need described in PA-16-233 “Prescription Drug Abuse” examining risks for
transition from therapeutic use to misuse, and effective prevention or risk reduction approaches for prescription
opioids. Over 51 million Americans undergo surgery annually, and opioids are a mainstay for pain
management. Opioids prescribed for surgery often instigate long-term use, and precipitate opioid misuse.
Surgery represents a critical event where the majority of patients require opioids regardless of prior opioid-
related adverse events, and patients taking opioids prior to surgery require higher doses over extended periods
compounding risks. Prior research identifies elevated depressive symptoms as a significant predictor of
prolonged postoperative opioid use. Also, patients with preoperative depression or opioid use may be at
increased risk for opioid misuse after surgery. Aim 1) of the project will characterize the relationship between
preoperative depressive symptoms and opioid use/misuse after surgery by utilizing a perioperative learning
healthcare system. The project aims to broadly assess pre-surgical patients for depressive symptoms, and to
characterize subsequent opioid-related risks by tracking longitudinal outcomes via the Collaborative Health
Outcomes Information Registry-CHOIR system. A prospective cohort of 558 patients, undergoing any elective
surgery, will undergo baseline and longitudinal testing via CHOIR (including NIH PROMIS measures of
emotional distress). After surgery, participants will report weekly changes in opioid use, opioid misuse, pain,
and adverse events for 1 year. We will compare targeted psychological screening via CHOIR to surveillance of
routinely available data on depression and antidepressant use in electronic health records (EHRs). We will
leverage free text existing in EHRs using data mining algorithms, and correlate self-reported opioid cessation
and opioid misuse with data from California’s prescription drug monitoring program (CURES 2.0). Aim 2) will
evaluate the relative efficacy of enhanced usual care (EUC) vs. motivational interviewing and guided opioid
weaning (MI+GOW) to promote opioid cessation and prevent opioid misuse after surgery in a high-risk cohort
(preoperative opioid users) and Aim 3) will characterize treatment interactions with participant attributes
(motivation for change, depressive symptoms), and longitudinal changes in depressive (self-loathing
symptoms) throughout treatment. This novel intervention fills a critical knowledge gap regarding evidence-
based methods for postoperative opioid tapering. 220 patients undergoing total hip or knee replacement taking
opioids both prior to and 2 weeks after surgery, will be randomized to EUC or MI+GOW after surgery and
followed for one year. The proposed research will have a marked impact on public health laying the foundation
for implementation of preoperative psychological screening, preoperative psychological optimizat...

## Key facts

- **NIH application ID:** 9960475
- **Project number:** 5R01DA045027-03
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** Jennifer Hah
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $503,485
- **Award type:** 5
- **Project period:** 2018-09-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9960475

## Citation

> US National Institutes of Health, RePORTER application 9960475, Psychological Risk Factors for Persistent Opioid Use and Prevention of Chronic Opioid Use and Misuse After Surgery: Postoperative Motivational Interviewing and Guided Opioid Weaning (5R01DA045027-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9960475. Licensed CC0.

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