Yale’s IMPOWR-YOU Center Bridges Gaps in Integrated Care for OUD and Chronic Pain

In the United States, over half of individuals with opioid use disorder (OUD) are also living with chronic pain. Despite this, treatment of OUD and chronic pain is largely provided in separate locations within the American healthcare system.

Clinical research driving treatment discovery and innovation in these two areas is similarly siloed. The IMPOWR-Yale Organizations United (YOU) Center at Yale School of Medicine has developed a robust model for engaging communities of people with lived experience of OUD and chronic pain.

“Traditionally, healthcare delivery for individuals with the combined conditions of chronic pain and opioid use disorder has meant that a patient may need to seek care in two to three locations—primary care, an opioid treatment program, and a pain specialist,” says William Becker, MD, co-principal investigator at IMPOWR-YOU and professor of medicine (general medicine). “Yale has been instrumental in developing models that provide integrated care for both conditions in one setting.”

Established in 2021, the center has launched two clinical trials and facilitated several cutting-edge pilot studies by early-career investigators exploring novel treatment solutions. The center joined several other institutions across the country as part of the National Institute on Drug Abuse newly created IMPOWR Research Network.

Funded with support from the National Institutes of Health Helping End Addiction Long-term (HEAL) Initiative, YSM and other IMPOWR Research Network grantees were charged with advancing patient-centered, integrated models of care for patients with OUD and chronic pain.

Patients have been integral in helping select the pilot studies.

“Engagement with communities is really baked into the structure of the center,” shares Declan Barry, PhD, professor of medicine (psychiatry) and in the Child Study Center at Yale and co-principal investigator of the center. “People with lived experience have been involved every step of the way from proposal to award and implementation alongside stakeholders in health systems leadership, clinical societies shaping medical practice, and patient advocacy groups.”

The pilot studies have also afforded early-stage investigators the opportunity to pursue small-scale projects with big potential.

One such study examined patient perspectives on satisfaction with clinical care among patients using prescribed and non-prescribed opioids. The study was led by Michele Buonora, MD, MS, MSHS, assistant professor of medicine at Albert Einstein College of Medicine, when she was a postdoctoral fellow at Yale, and Christin Veasley, co-founder and director of the Chronic Pain Research Alliance, and an individual with lived experience of chronic pain.

“Co-leading a study with someone with lived experience of chronic pain—and guided by a diverse team of patients, veterans, insurers, clinicians, scientists, and advocates—was a transformative experience,” reflects Buonora. “This approach was essential in shaping our research question into a rigorous study with rich findings and implications relevant and useful to those most impacted by our work.”

The center houses two core clinical trials: Pain CHAMP (Pain Care at Home to Amplify Function) and SC-POWR (Stepped Care for Patients to Optimize Whole Recovery).

The Pain CHAMP study compares two promising interventions—pharmacist collaborative management (PCM) and PCM with cooperative pain education and self-management (COPES) —among participants receiving long-term opioid therapy.

“The participants may benefit from reassessment of their opioid treatment plan due to concern for opioid misuse or OUD,” says Anne Black, PhD, associate professor of medicine (general medicine) and investigator at the center.

Led by Black and Becker, the study examines opioid prescription and pain management from a specialized clinical team consisting of a pharmacist and a physician.

“Once the patient is stabilized in their opioid regimen or transitioned to other treatment options, they are transferred back to continue management in primary care,” adds Black. “We’re interested in the benefits of this approach and to what extent the addition of COPES within this model further improves patient outcomes.”

The SC-POWR clinical trial’s aim is to improve a broad range of outcomes for individuals with OUD, including retention in treatment, pain, depression, anxiety, and post-traumatic stress disorder.

Situated within three opioid treatment programs operated by the APT Foundation, the study provides CBT training to counseling staff and is evaluating care outcomes among participants randomized to receive CBT from these counselors, as well as those “stepped up” to additional interventions, including stress reduction groups and exercise programs.

“Stress reduction and exercise can be helpful to manage pain and improve quality of life. Engaging patients in sustainable exercise routines can bring notable improvements; many patients are afraid that exercise will make their pain worse, but find that it brings some relief,” says Barry, the principal investigator.

Center investigators note that the trials are approaching completion, and that planning for further research, informed by the trial findings, is in progress.

The findings from five pilot studies and two clinical trials will be made available to the broader IMPOWR Research Network in early 2027, enabling other institutions and researchers conducting similar work to access the data.

“The progress that the IMPOWR Network has made in addressing common but understudied conditions is palpable. The collaborations will continue and result in better science and improved treatments for years to come,” says David A. Fiellin, MD, professor of medicine (general medicine), of emergency medicine, and of public health, and co-principal investigator of IMPOWR-YOU.

The research team at Yale will continue to engage key institutional and community partners to advance the lives of persons who experience chronic pain and OUD.

The Yale Program in Addiction Medicine works to expand access to and improve effectiveness of diagnosis, prevention, treatment, and harm reduction services for substance use. Our efforts span clinical practice, research, education, and policy. We provide evidence-based clinical care, conduct rigorous and innovative research, train the next generation of addiction specialists, and engage in policy and advocacy initiatives at the local, state, and national levels. Learn more about how you can support this and other practice-changing work.