Effectiveness of 2 behavioral interventions for voluntary opioid dosage reduction in patients prescribed high-dosage opioids for chronic pain

Abstract

Studies of behavioral interventions for opioid reduction, which have included individuals prescribed low-, moderate-, and high-dosage opioids for chronic noncancer pain, generally show small to no effect on opioid dosage. We compared the effectiveness of motivational interviewing plus cognitive behavioral therapy (MI + CBT) vs shared decision-making (SDM) on change in opioid dosage in a large pragmatic randomized trial. This study is a secondary analysis examining subgroup differences between participants prescribed high-dosage opioids (≥90 morphine milligram equivalents [MME])-who are at the highest risk for adverse events-and those prescribed lower dosages (<90 [MME]) at baseline. The primary outcome was change in average daily opioid dosage at 12 months postbaseline using prescribing data from electronic health records. Exploratory analysis evaluated potential baseline predictors of the primary outcome. Among participants prescribed high-dosage opioids at baseline, average daily opioid dosage at 12 months decreased similarly in both intervention groups: -33 MME (95% CI, -44 to -21) in the MI + CBT group and -25 MME (95% CI, -37 to -12) in the SDM group. In both groups, participants prescribed low-to-moderate dosages at baseline had essentially no dosage change. Baseline dosage was the strongest predictor of opioid reduction for both intervention groups. Both MI + CBT and SDM may be useful in decreasing opioid dosages among individuals prescribed high-dosage opioids for chronic noncancer pain. Researchers and clinicians should consider focusing dosage reduction efforts on individuals prescribed high-dosage opioids.