Introduction
Subthreshold OUD, OUD
DISORDER, DISORDER, PCP, LITTLE
Responses to the opioid crisis have focused on decreasing opioid prescribing, reducing fatal overdoses, and increasing access to medications for opioid use disorder (OUD). Little attention has been paid to preventing the progression to moderate or severe OUD among people who exhibit risky opioid use behavior, which includes nonmedical use of prescribed opioids or any use of illicit opioids. Subthreshold OUD consists of risky opioid use (e.g. taking illicit opioid or nonmedical use of prescription opioid) that does not meet the threshold for treatment with opioid agonists or antagonists (e.g. moderate or severe OUD as defined by DSM-V criteria of 4 or more criteria) [Most prior approaches to reducing subthreshold drug use in general medical settings have relied on single-contact brief interventions [Collaborative care is an established approach for improving mental health conditions in primary care patients, [The Sub-Threshold Opioid Use Disorder Prevention (STOP) Trial is designed to study the efficacy of elements of a collaborative care intervention to reduce risky opioid use and to prevent progression to moderate or severe OUD in adult primary care patients with risky opioid use. The STOP intervention augments previously tested care models by combining PCP brief advice and telephone health coaching along with a nurse care manager working with the PCP. The STOP intervention thus combines patient-facing and provider-facing components. The purpose of this report is to describe the STOP trial protocol.