Purpose Improving care around prescription opioids and increasing safety among Veterans seen in Veterans Health Administration (VHA) primary care clinics is a critical public health issue. POST is a pragmatic, randomised controlled trial, for reducing opioid risk, comparing the effectiveness of a brief, tailored Motivational Interviewing (MI) intervention with an Enhanced Usual Care (EUC) control.

Methods Participants (n~450, ongoing recruitment) on current chronic opioid therapy will complete a baseline questionnaire, a voluntary urine screen, and are randomised to either MI or EUC therapy sessions. Research staff that are integrated into the primary care-mental health treatment team deliver these interventions. Follow-up interviews are conducted over the course of one-year.

Results To date, 25 individuals have been randomised. MI and EUC procedures have been feasible and acceptable to patients. Participants receiving high dosages of opioids have generally been highly knowledgeable about opioid safety practices. Thus far, all have had previous conversations with providers about reducing their prescription dosages. Qualitative interviews with the patients’ prescribers indicated an investment in patient safety and willingness to collaborate with therapists providing opioid safety counselling.

Significance and Contributions In addition to amending opioid prescription guidelines, concurrent strategies are necessary to address patient behaviours that increase overdose risk. This intervention adds to current knowledge and practices surrounding opioid prescribing, and intends to decrease opioid-related injuries. If effective, primary care clinics may incorporate this intervention into usual care practices.

Conclusions Brief, motivational interventions focused on opioid overdose risk are acceptable to many patients prescribed chronic opioid therapy. We aim to enhance patients and providers engagement in valuable conversations about opioid prescription usage and safety. Prescribers are committed to learning more about how to improve care and safety in this population.