# Developing and pilot testing an intervention to increase opioid tapering in primary care

> **NIH NIH K23** · ALBERT EINSTEIN COLLEGE OF MEDICINE · 2020 · $199,260

## Abstract

ABSTRACT
 With the career goal of becoming an independent investigator, Hector R. Perez, MD, MS, describes a
mentored research project and specific career development plan which will prepare him to develop and test
interventions to improve health outcomes among patients taking opioid pain relievers (OPRs) for chronic pain.
Use of OPRs for chronic pain is widespread in primary care settings despite consistent evidence of harm for
this clinical indication. Guidelines recommend reducing or discontinuing (tapering) OPRs when risks exceed
benefits, such as for patients taking high-dose OPRs with poorly controlled pain. However, there are numerous
barriers to initiating and maintaining OPR tapers in primary care settings, including the concern that patients
will elect to seek care elsewhere and not be retained in primary care. This project seeks to increase OPR
tapering in primary care in a select group of high risk patients by implementing a protocol-based
tapering intervention (TapPro) that provides patient and provider support, delivered by a nurse within a
primary care setting. Using the Social Cognitive Theory as a framework, the intervention will be developed
based on tapering guidelines by the Washington State Agency Medical Directors’ Group and adapted based on
qualitative interviews with patients and primary care providers (PCPs).
 This proposal aims to: 1) identify barriers to and facilitators of OPR tapering among patients with high OPR
dose and among PCPs, 2) develop a protocol-based tapering intervention (TapPro) to increase tapering in
primary care that addresses barriers and facilitators of OPR tapering, and 3) test the feasibility and preliminary
efficacy of TapPro versus standard of care (SOC) in a pilot RCT of 60 patients taking high-dose OPRs (≥100
mg morphine-equivalent daily dose) with persistent chronic pain. Our primary feasibility outcome is retention in
primary care, defined as the number of PCP follow-up visits during the 6-month intervention. Our primary
efficacy outcome is any change in OPR dose over time during the 6-month intervention. We hypothesize that
TapPro will be associated with similar retention in primary care and a greater OPR dose reduction compared to
SOC.
 Through completion of the proposed research and career development plan, Dr. Perez will gain skills in
research methods to study OPR use for chronic pain, advanced qualitative methods, the design and conduct of
randomized controlled trials, and the statistical analysis of complex longitudinal data. The proposed research
will lead to an R01 application to test TapPro in a large randomized controlled trial. Together, these activities
will be instrumental in advancing Dr. Perez’s goal to become an independent investigator.

## Key facts

- **NIH application ID:** 9993485
- **Project number:** 5K23DA044327-05
- **Recipient organization:** ALBERT EINSTEIN COLLEGE OF MEDICINE
- **Principal Investigator:** Hector Ruben Perez
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $199,260
- **Award type:** 5
- **Project period:** 2017-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9993485

## Citation

> US National Institutes of Health, RePORTER application 9993485, Developing and pilot testing an intervention to increase opioid tapering in primary care (5K23DA044327-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9993485. Licensed CC0.

---

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