Study Finds Collaborative Opioid Pain Care Works Just as Well for Patients With Substance Use Disorder

A new secondary analysis of a large pragmatic randomized trial suggests that chronic pain patients with substance use disorder can benefit just as much from structured, team-based opioid care as patients without that diagnosis. Published in the Journal of General Internal Medicine, the study found that veterans on long-term opioid therapy who had potential substance use disorder at baseline showed the same meaningful improvements in pain interference and pain intensity over 12 months, along with similar reductions in prescription opioid dose.

The research was led by Benjamin J. Morasco of the VA Portland Health Care System and Oregon Health & Science University. It used data from the Veterans’ Pain Care Organizational Improvement Comparative Effectiveness study, or VOICE, a multisite trial that tested two real-world versions of collaborative care for chronic pain. In this model, primary care teams work with specialists to manage patients systematically rather than relying on ad hoc treatment decisions.

Participants were assigned to either an intensive interdisciplinary pain team or a less resource-intensive pharmacist-led collaborative management approach. Although the two interventions differed in intensity, both followed the same collaborative care structure and were carried out in routine Veterans Health Administration settings, making the study pragmatic rather than a highly controlled laboratory-style trial.

For this analysis, the investigators combined both treatment groups and asked whether baseline substance use disorder status affected outcomes. Of the 778 people enrolled, 250, or 32.1 percent, met criteria for potential substance use disorder at the start of the study. That proportion is notable and is consistent with wider evidence showing that about one in three patients receiving long-term opioid therapy for chronic pain has a co-occurring substance use disorder.

The two groups were not identical at baseline. Patients with potential substance use disorder tended to be younger and were more likely to have mental health comorbidities. Even so, there were no baseline differences between groups in pain interference, pain intensity, or prescription opioid dose. The researchers used validated tools, including the Brief Pain Inventory, to measure both the severity of pain and how much it disrupted daily life.

After 12 months, both groups improved. Patients with and without potential substance use disorder showed statistically significant reductions in pain interference, pain intensity, and opioid dose. Adjusted analyses found no meaningful difference in the size of those changes between groups, indicating that substance use disorder did not reduce the benefit of collaborative care or prevent dose reduction.

The finding matters because earlier studies had focused on pain interventions designed specifically for people in substance use disorder treatment. Those studies showed promise, but they did not answer whether standard collaborative pain care used in ordinary health systems would work as well. This analysis helps fill that gap by testing the question within a randomized trial of mainstream care.

The opioid reduction results are especially relevant in light of concerns about tapering. Past reviews and observational studies have linked rapid or forced opioid dose reductions to harmful outcomes, including overdose and mental health crises. In contrast, this trial paired dose reduction with active pain treatment, and patients with potential substance use disorder did not experience worse pain outcomes than others. That suggests dose reduction is safest when it happens within a supportive treatment framework.

Several features strengthen the study’s practical value. It was conducted in ordinary VA primary care settings, involved multiple sites, and included enough participants to detect meaningful differences if they existed. Potential substance use disorder was identified with validated screening approaches, including tools such as AUDIT-C and TAPS, along with diagnostic codes that have been checked in prior work. The trial was registered at ClinicalTrials.gov as NCT03026790 and was funded by the Patient-Centered Outcomes Research Institute with support from the Department of Veterans Affairs.

The authors also noted limitations. The study population was made up of veterans, so the results may not fully generalize to civilian populations with different care systems. Substance use disorder was based on screening and potential criteria rather than structured interviews, and outcomes were assessed over 12 months rather than longer periods. Even so, the consistency of the findings across pain interference, pain intensity, and opioid dose supports the main conclusion.

Overall, the study suggests that substance use disorder should not be treated as a reason to withhold structured chronic pain care. Roughly a third of patients on long-term opioid therapy have a substance use disorder diagnosis, and clinicians often struggle with whether to focus on pain or addiction first. These results indicate that collaborative care can address both pain and opioid dose reduction without leaving patients with substance use disorder behind.

Subject of Research: Collaborative care treatment outcomes for chronic pain and opioid dose reduction in patients with and without substance use disorder

Article Title: Pain and Opioid Dose Reduction Based on Substance Use Disorder Status: Secondary Analysis from a Pragmatic Effectiveness Trial

Article References: Morasco, B. J., Hammett, P. J., Krebs, E. E., Seal, K. H., DeRonne, B. M., Lovejoy, T. I., Bohnert, A. S. B., Frank, J. W., Makris, U. E., Naylor, J. C., Painter, J. T., Borsari, B., Hagedorn, H. J., & Becker, W. C. Pain and Opioid Dose Reduction Based on Substance Use Disorder Status: Secondary Analysis from a Pragmatic Effectiveness Trial. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10816-6

Image Credits: AI Generated

Keywords: substance use disorder, chronic pain, long-term opioid therapy, opioid dose reduction, collaborative care, pragmatic trial, veterans health, pain interference, pain intensity, primary care, comparative effectiveness, opioid prescribing

Cite Scienmag News

Ophelia Keating. Scienmag. https://scienmag.com/chronic-pain-patients-with-substance-use-disorder-benefit-equally-from-collaborative-opioid-care-trial-finds/

Ophelia Keating. "Chronic Pain Patients With Substance Use Disorder Benefit Equally From Collaborative Opioid Care, Trial Finds." Scienmag, https://scienmag.com/chronic-pain-patients-with-substance-use-disorder-benefit-equally-from-collaborative-opioid-care-trial-finds/.