Search the Library
NOTE: This is a new search platform (as of May 2026). If you do a search and don’t get the results you were expecting, please email us at ctnlib@uw.edu to let us know? (If possible, please share your exact search strategy. Thank you!)
Enter keywords and hit Enter (or click the magnifying glass) to search. You can then also select document type or subject/topic to narrow results further (or just use those for searching without a keyword). Results display below this search form.
Document types
Subjects
- CTN-#### format for protocols (CTN-0001, e.g.)
- “exact phrase” (if phrase is not found, it will return results that contain all terms
- word1 NOT word2
- word1 word2 (finds both words)
- Click title to access full-text
- “Show details” reveals abstract & other info
- Checkboxes select items for copy/pasting or printing
- Need help getting a copy of a journal article?
Email ctnlib@uw.edu
Search results
As the opioid epidemic continues to have a major negative impact across the US, community pharmacies have come under scrutiny from legal systems attempting to hold them accountable for their role in over-dispensing and lack of patient intervention. While the most available tool for monitoring patients’ opioid use is Prescription Drug Monitoring Programs (PDMP), these do not provide pharmacists with actionable information and decision support. Our study addresses this gap through three objectives: [1] incorporate validated opioid risk metric thresholds into a PDMP platform to create the Opioid Risk Reduction Clinical Decision Support (ORRCDS) tool; [2] assess ORRCDS’ ability to reduce patient opioid risk; [3] assess ORRCDS’ sustainability and viability for broader dissemination in community pharmacy.
For objective 1, our team is partnering with leadership from the largest US PDMP organization and a top-five pharmacy chain to implement ORRCDS into the pharmacy chain’s workflow following the Guideline Implementation with Decision Support (GUIDES) framework. For objective 2, our team will conduct a type-1 implementation mixed methods study using a 2-arm parallel group clustered randomized design. We anticipate enrolling ~6,600 patients with moderate and high opioid use risk during the 6-month enrollment phase across 80 pharmacies. This sample size will provide 96.3% power to detect a 5% or greater difference in responder rate between the intervention and control arm. Responders are patients with moderate-risk at baseline who reduce to low-risk or those with high-risk at baseline who reduce to moderate or low-risk at 180 days post last intervention. To accomplish objective 3, we will use the Consolidated Framework for Implementation Research (CFIR) to develop and execute cross-sectional qualitative interviews with pharmacists (n=15), pharmacy leaders (n=15), and PDMP leaders (n=15) regarding long term adoption and sustainability of the ORRCDS tool.
Conclusions: A PDMP tool that addresses moderate- and high-risk opioid use is not available in community pharmacy. This study will implement ORRCDS in a large retail pharmacy chain that will include additional screening and guidance to pharmacy staff to address risky opioid medication use. Our results will make critical advancements for protecting patient health and addressing the opioid epidemic.
Related protocols: CTN-0138
The Centers for Disease Control and Prevention’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pain cautioned that inflexible opioid prescription duration limits may harm patients. Information about the relationship between initial opioid prescription duration and a subsequent refill could inform prescribing policies and practices to optimize patient outcomes. We assessed the association between initial opioid duration and an opioid refill prescription.
Using data drawn from a multi-site prescription opioid registry developed by CTN-0084, conducted a retrospective cohort study of adults =19 years of age in 10 US health systems between 2013 and 2018 from outpatient care with a diagnosis for back pain without radiculopathy, back pain with radiculopathy, neck pain, joint pain, tendonitis/bursitis, mild musculoskeletal pain, severe musculoskeletal pain, urinary calculus, or headache. Generalized additive models were used to estimate the association between opioid days’ supply and a refill prescription.
Overall, 220,797 patients were prescribed opioid analgesics upon an outpatient visit for pain. Nearly a quarter (23.5%) of the cohort received an opioid refill prescription during follow-up. The likelihood of a refill generally increased with initial duration for most pain diagnoses. About 1 to 3 fewer patients would receive a refill within 3 months for every 100 patients initially prescribed 3 vs. 7 days of opioids for most pain diagnoses. The lowest likelihood of refill was for a 1-day supply for all pain diagnoses, except for severe musculoskeletal pain (9 days’ supply) and headache (3-4 days’ supply).
Conclusions: Long-term prescription opioid use increased modestly with initial opioid prescription duration for most but not all pain diagnoses examined.
Related protocols: CTN-0084
This is the primary outcomes paper for CTN-0124.
This paper aims to address the challenges in providing adequate access to Medications for Opioid Use Disorder (MOUDs) within underserved areas by examining the potential role of pharmacies and proposing actionable strategies for improvement. The health system faces increasing criticism for failure to provide adequate access to MOUDs. Pharmacies are being promoted as an asset to increase MOUD access in rural and underserved areas.
Method: An engineering systems analysis approach was employed to investigate ways to enhance pharmacy roles in delivering MOUDs in underserved regions. Interviews were conducted with community pharmacists, pharmacy associations, and addiction treatment experts. Innovation development techniques with experts from inside and outside the field were used to create recommendations.
Results: The findings underscore the importance of embracing technological advancements to overcome resource limitations and expand MOUD access in underserved areas. When our project began, we believed pharmacy roles related to MOUD distribution could expand through traditional means. We now feel that expansion is practical only through adoption of recent developments in information and communication technology. Our recommendations offer actionable strategies to expand MOUD availability in underserved areas. Technological changes can address stigma and mindsets, workflow simplification, family engagement, integration with other parts of the health system, reimbursement practice, and regulation.
Conclusions: Implementing pertinent technological innovations could augment MOUD availability within the pharmacy sector, thus addressing the pressing need for improved access to treatment in underserved communities. These technological changes would expand MOUD access within a field constrained by limited and diminishing resources.
Related protocols: CTN-0124
Prescription Drug Monitoring Programs (PDMPs) are intended to help reduce prescription drug misuse and opioid overdose, yet little is known about the longitudinal patterns of opioid prescribing that may be associated with mortality. This study investigated longitudinal opioid prescribing patterns among patients with opioid use disorder (OUD) and without OUD in relation to mortality using PDMP data.
Growth modeling was used to examine opioid prescription data from the California PDMP for a 4-year period before death or a comparable period ending in 2014 for those remaining from a sample of 7728 patients (2576 with OUD, and 5152 matched non-OUD controls) treated in a large healthcare system.
Compared to controls, individuals with OUD (alive and deceased) had received significantly more opioid prescriptions, greater number of days’ supply, and steeper increases of opioid dosages over time. For morphine equivalents (ME, in grams) the interaction of OUD and mortality was significant at both intercept and slope; deceased OUD patients demonstrated the sharpest increase (an average yearly increment of 7.84 grams over alive patients without OUD) and ended with the highest level of opioids prescribed before they died (20.2 grams higher). Older age, public health insurance, cancer, and chronic pain were associated with higher number and dose of opioid prescriptions.
Conclusions: Prescription Drug Monitoring Programs offer important resources useful for monitoring physician and patient behaviors to determine potentially unsafe prescription and usage patterns. The database can also be used to identify patients at risk for misuse and related adverse consequences based on prescriptions received for opioids and other drugs. In addition to high levels of opioid prescriptions, clinicians need to pay special attention to escalating patterns of prescription dosage, which can be a critical warning signal for heightened mortality risks, particularly among OUD patients.