Reducing Stigma Toward People With Opioid Use Disorder Among Primary Care Clinicians
Phase: NA
Conditions: Opioid-use Disorder, Opioid Dependence, Attitude of Health Personnel
Sponsor: HealthPartners Institute

Reducing Stigma toward People with Opioid Use Disorder among Primary Care Clinicians 
          (Secondary ID: 3UG1DA040316-06S4) 
 
 
 
NCT04867382 
Nov. 23, 2021 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Reducing Stigma toward People with Opioid 
Use Disorder among Primary Care Clinicians 
 
 
 
 
 
 
 
HEAL Initiative Supplement to NIDA CTN 0095: COMPUTE 2.0 
3UG1DA040316-06S4 
 
 
 
 
 
 
Protocol 
Version 6.0 
Nov. 23, 2021 
 
 
 

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STUDY TEAM: 
Stephanie Hooker, PhD, MPH; Site Principal 
Investigator, HealthPartners 
Rebecca Rossom, MD, MS; Co-Investigator; Co-
lead of CTN 0095; HealthPartners; NorthStar Node 
A. Lauren Crain, PhD; Co-Investigator, 
HealthPartners 
Gavin Bart, MD, PhD; Co-Investigator; Principal 
Investigator of the NorthStar Node; Hennepin 
Health; University of Minnesota 
Amy LaFrance, MPH; Project Manager, 
HealthPartners 
Sheryl Kane; Programmer, HealthPartners 
 
NIDA CCTN Scientific Officer: 
Kristen Huntley, PhD 
 
 
 
 

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A. Summary 
The prevalence of opioid use disorder (OUD) and opioid-related deaths have risen 
dramatically in recent years. Effective treatments, including medications for opioid use 
disorder (MOUDs; e.g., buprenorphine-naloxone and methadone) are under-utilized. 
Primary care offers an ideal setting in which to treat OUD; however, few clinicians are 
waivered to prescribe buprenorphine and of those who are waivered, less than one-third 
do prescribe. One potential barrier to increasing access to MOUDs is primary care 
clinician (PCC) stigma towards people with OUD. This study will use a randomized 
controlled trial design to examine a novel intervention to reduce stigma towards people 
with OUD among PCCs. PCCs in clinics randomized in COMPUTE 2.0 to the 
intervention (in 15 of the 30 clinics randomized in the parent study) will be randomized 
1:1 to the stigma reduction or comparison training, stratified by clinic and waiver status. 
Training will be conducted via MyLearning, an online learning software. PCCs will be 
asked to complete a brief training on the clinical decision support (CDS) tool, Opioid 
Wizard. PCCs in the stigma reduction intervention will hear patient narratives designed 
to reduce stigma about patients with OUD. PCCs in the comparison training will not get 
any stigma content, but will have training on using the clinical decision support tool. 
Immediately following the training, the PCCs will complete a survey of stigma beliefs and 
intentions to get waivered to prescribe buprenorphine. Use of the CDS will be monitored 
in both groups for 6 months.  
 
B. Background and Rationale 
Two-thirds of the more than 70,000 drug overdose deaths in the United States in 2017 
involved an opioid, representing a 12% increase in opioid-related deaths from 2016.1 
Given the rise in opioid-related deaths, increasing the availability and uptake of 
efficacious treatments for OUD is critical. However, only 20% of patients diagnosed with 
OUD seek treatment, and only 25% of those receive MOUDs.2 MOUDs, including 
buprenorphine and naltrexone, can be used to treat OUD in primary care settings, which 
could widely increase the availability of treatment.3 In response to guidelines published in 
2016 by the Centers for Disease Control and Prevention (CDC) on prescribing opioids,4 
health systems are encouraging PCCs to reduce opioid prescribing and identify and treat 
OUD. However, there is a shortage of clinicians waivered to prescribe buprenorphine; in 
April 2020, there were 85,875 waivered clinicians in the United States, representing less 
than 10% of US licensed physicians.5 Further, less than one-third of the clinicians 
waivered to prescribe buprenorphine do.6 Clinicians cite time, poor access to clinical 
guidelines, and lack of confidence as barriers to prescribing buprenorphine.7-9 
An additional potential barrier to scaling up MOUD treatment in primary care is stigma 
about people with OUD. Health-related stigmas are social processes by which people are 
labeled, stereotyped, devalued, and rejected because they have a health condition.10 
Stigmas about a health condition occur when a person perceives a difference between 
themselves and the person with the health condition, which leads to disdain for that 
person.11,12 People with substance use disorders (SUDs) are more stigmatized than 
people with other conditions, including mental illness and physical disabilities.13,14 
Common stereotypes about people with SUDs include that they are to blame for their 
condition (and have personal control over their substance use), dangerous, unpredictable, 
have no job potential, and are criminals.15-17 Indeed, substance use is often viewed as a 
moral and criminal issue, rather than a chronic illness.16 Despite the clear implications of 
the impact of stigma on patients with SUDs, there is relatively little empirical literature on 
stigma for SUDs in general15 and OUD in particular.18 
Stigma is considered a “major driver” behind the lack of access to MOUDs, because of (1) 
the misconception that addiction is a volitional choice, not a disease; (2) the separation of 
addiction treatment from the rest of the medical system; (3) the language used for 
addiction (e.g., calling urine drug screens “clean” or “dirty” or patients “addicts” or 
“junkies”); and (4) the criminal justice system not including medical judgment in the 

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treatment of people with OUD (e.g., not allowing incarcerated patients to take 
MOUDs).19,20 Further, patients may avoid seeking treatment because they fear being 
labeled as an “addict.”15 Even within the SUD treatment community, taking a MOUD is 
stigmatized as a “crutch” or “trading one addiction for another.”21(p.328) Offering MOUDs in 
primary care has the potential to reduce stigma and to increase the likelihood that patients 
will seek treatment for OUD.22,23 Although there is a dearth of research on PCC stigma 
toward people with OUD, one nationally representative study of over 1000 physicians 
found physicians hold many of the same stigma beliefs as the general public.24 In 
particular, the majority of physicians endorsed the belief that patients were individually 
responsible for their OUD (89%), desired social distance from people with OUD (not 
wanting a person with OUD to marry into the family [79%] or work with them on the job 
[77%]), and viewed patients with OUD as more dangerous (69%) than the general 
population.24 Preliminary evidence suggests that clinician stigma leads to withholding of 
primary care25,26 and pharmacy services27,28 to patients with SUDs, especially among 
those who inject opioids.29 Further, clinician beliefs that buprenorphine may attract an 
undesirable patient population may limit the number of clinicians who get waivered and 
offer buprenorphine in primary care.26 
There are few evidence-based interventions for reducing OUD stigma in the general 
public and especially among healthcare clinicians. Common approaches to reducing 
health-related stigma in the public are to provide education, facilitate contact between 
persons affected by the condition and members of the general public, and target popular 
opinion leaders or change agents.30,31 Two systematic reviews of stigma interventions, 
one for SUDs specifically32 and one for health-related conditions in healthcare settings,33 
found a total of 16 interventions to reduce stigma of SUDs. Only two of these 
interventions were specifically for practicing healthcare clinicians,34,35 an additional four 
were for medical students,32 and one was for psychiatry residents.36 Intervention content 
and mode of delivery varied significantly, but they generally used a combination of 
education and direct contact with people with SUDs. The authors conclude that improving 
attitudes about people with SUDs may be best achieved through communication 
strategies that promote positive stories and demonstrate that stigmatized characteristics 
are not representative of all people in a stereotyped group.32 Others have suggested that 
combining personal narratives from individuals being treated with MOUDs with science-
based education about OUD and the benefit of MOUDs could be particularly impactful.19 
Additionally, clinicians can learn to “disentangle behavior from identity” by using language 
that frames addiction as a treatable health condition and not a personal failing.37 
This study is innovative in that in proposes to examine a new intervention to reduce PCC 
stigma of persons with OUD. To our knowledge, only two interventions have been 
studied to reduce stigma of patients with SUDs among practicing healthcare 
clinicians,34,35 and both targeted SUD in general, not OUD specifically. Further, both used 
quasi-experimental designs without a control group. The current study will use a 
randomized controlled trial (RCT) design embedded in a larger, multisite trial of a clinical 
decision support (CDS) tool to help PCCs identify, diagnose, and treat patients with 
OUD. The intervention will be time and cost efficient by integrating the training into an 
existing training for the Opioid Wizard tool and delivering the additional content through 
an e-Learning platform, a commonly used mode of delivery for delivering training to 
practicing clinicians. However, we are unaware of any stigma reduction interventions that 
have used this mode to deliver training to PCCs. Further, the intervention will incorporate 
patient narratives to combat commonly held stereotypes about people with OUD, provide 
evidence-based education about the effectiveness of MOUDs, and use person-first 
language (people who have OUD versus “addicts”) to reduce PCC stigma of patients 
with OUD. Previous stigma reduction interventions in PCCs have emphasized 
educational approaches, which have been shown to be less effective than patient 
contact and narratives.38 Finally, in addition to assessing stigma beliefs and intention to 
get waivered, the study will examine objective assessments of PCC behavior, including 

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use of the Opioid Wizard tool and secondary outcomes of change in waiver status and, 
among waivered clinicians, buprenorphine prescribing behavior. 
C. Objectives, Aims, & Hypotheses 
In response to NOT-OD-101: HEAL Initiative: Notice of Special Interest (NOSI) regarding 
the Availability of Administrative Supplements to Support Strategies to Reduce Stigma in 
Pain Management and OUD and Treatment, this project will evaluate an intervention to 
reduce stigma in PCCs by integrating stigma reduction training into the Opioid Wizard 
training. PCCs will be randomized to this novel stigma reduction training, grounded in 
stigma science, or an attention-control training. The overall goal of this project is to 
determine whether stigma reduction training reduces PCC stigma, increases intention to 
get waivered to prescribe buprenorphine or to prescribe buprenorphine if a waiver were 
no longer required, and ultimately increases the likelihood that PCCs use Opioid Wizard. 
Aim 1: To examine whether a PCC training to reduce stigma toward people with 
OUD, compared to an attention-control training, reduces stigma, increases 
intention to get waivered, increases intention to prescribe buprenorphine if a 
waiver were no longer required, and increases the likelihood of using Opioid 
Wizard. 
H1a: PCCs who are randomized to stigma reduction training will report less stigma 
towards patients with OUD compared to PCCs who are randomized to control 
training. 
H1b: Among non-waivered PCCs, PCCs who are randomized to stigma reduction 
training will report greater intention to get waivered to prescribe buprenorphine than 
PCCs who are randomized to control training. 
H1c: Among non-waivered PCCs, PCCs who are randomized to stigma reduction 
training will report greater intention to prescribe buprenorphine for OUD in the next 
year if a waiver were no longer required than PCCs who are randomized to control 
training.  
H1d: PCCs who are randomized to stigma reduction training will use Opioid Wizard 
at a greater proportion of visits where the PCC is alerted to high risk than PCCs who 
are randomized to control training. 
Aim 2: Examine the relationship between PCC stigma and intention to get 
waivered, and likelihood of using Opioid Wizard. 
H2a: Among non-waivered PCCs, PCCs who report lower stigma will report greater 
intention to get waivered to prescribe buprenorphine. 
H2b: PCCs who report lower stigma will be more likely to use Opioid Wizard at 
flagged visits. 
As secondary outcomes, we will gather additional objective measures of PCC behavior, 
including PCC prescribing and referral behavior and new waivers among previously non-
waivered PCCs. In secondary analyses, we will examine if waiver status at the time of 
the intervention moderates the impact of the intervention on stigma attitudes and use of 
Opioid Wizard. Additionally, in exploratory analysis, we will examine whether stigma 
mediates the effect of the intervention on Opioid Wizard use and if receiving the stigma 
and/or control intervention increases the number of PCCs getting waivered or the 
number of patients receiving treatment (prescriptions or referrals for treatment). Results 
of this work will inform future interventions aimed at reducing stigma among PCCs for 
OUD and a variety of other stigmatized health conditions, including other SUDs. 
 
D. Study Parent Trial, Setting, and Design 
a. Parent Trial. COMPUTE 2.0 is funded by the NIDA National Drug Abuse Treatment 
Clinical Trials Network (CTN-0095) to implement and test a web-based CDS tool 
(“Opioid Wizard”) that guides PCCs in the diagnosis and treatment of OUD. 

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Outcomes include rates of OUD diagnosis, naloxone rescue kit orders, MOUD 
orders, and emergency department visits and hospitalizations. The CDS for Opioid 
Wizard alerts PCCs to (a) patients at elevated risk for OUD or opioid overdose using 
an EHR-based risk calculator, (b) patients with recent opioid overdose, and (c) 
patients with previously diagnosed OUD or MOUD orders. Opioid Wizard then guides 
PCCs through the screening and diagnosis of patients with OUD and starting patients 
with OUD on MOUDs. Opioid Wizard identifies and flags for specialty referral patients 
with relative contraindications to treatment of OUD in primary care, including 
pregnancy or severe liver disease. It provides a one-page patient handout that 
summarizes treatment options for OUD, including key differences in MOUDs 
(buprenorphine, extended-release intramuscular naltrexone, methadone). For 
buprenorphine waivered PCCs, It provides step-by-step guidance on starting 
buprenorphine at-home or in-clinic, supported by interactive patient handouts that 
guide at-home dose escalation of buprenorphine for three different starting doses 
(see Figure 1 for Opioid Wizard screenshot). For all PCCs, it facilitates referrals to 
buprenorphine-waivered PCCs or specialty care colleagues. It also guides screening 
for common comorbid conditions, including depression, anxiety and infectious 
diseases, counseling for safer use of intravenous drugs, and guidance for use of HIV 
pre-exposure prophylaxis (PrEP). The goal of Opioid Wizard is to improve rates of 
diagnosis and treatment for patients with OUD by addressing PCC barriers of lack of 
time, access to clinical guidelines, and confidence in diagnosing OUD. With this 
supplement, we will be able to address the additional barrier of stigma. See CTN- 
0095 Protocol for specific details about the main study’s protocol. 
b. Study Setting. This administrative supplement will be implemented at 
HealthPartners. HealthPartners is the largest consumer-governed nonprofit 
healthcare organization in the country. HealthPartners has 55 primary care clinics 
and cares for more than 1.2 million patients in Minnesota and western Wisconsin. 
Patients are insured by a mix of insurance types, including Medicaid (12%), Medicare 
(12%), commercial insurance (60%) and others. At HealthPartners, approximately 
7% of PCCs are currently waivered to prescribe buprenorphine. This study will be 
conducted in the 30 HealthPartners primary care clinics randomized in COMPUTE 
2.0. Each randomized clinic has at least 3 eligible PCCs and 50 adult patients who 
are aged 18-75 years and have an OUD diagnosis, are prescribed a MOUD, or are 
identified by the opioid risk calculator as being at high risk of OUD. The proposed 
supplement fits well within the scope of the parent award. 
c. Study Design. This study will use a randomized controlled trial design, in which 
PCCs will be randomized to receive one of two trainings delivered via MyLearning: a 
stigma reduction training or an attention control training. Outcome assessments will 
occur immediately following the training delivery (PCC initial survey), at 3 months 
following training completion (PCC follow-up survey), and in the 6 months following 
the training (objective indicators of PCC Opioid Wizard use, waivered clinician 
prescribing behavior, and waiver status). See Figure 1 for a schematic of the study 
flow. 
 
 

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Stigma 
Reduction 
Training
Randomization
Comparison 
(Attention 
Control) 
Training
Immediate 
Post Survey
3 month 
Follow-up 
Survey
PCC Behavior (6-months)
 
Figure 1. Study flow diagram. 
 
 
E. Study Population 
a. Participants. Participants will be PCCs who practice at HealthPartners Clinics that 
have been previously randomized to the intervention arm of the parent study, Opioid 
Wizard. There will be 15 clinics randomized to receive the Opioid Wizard 
intervention. There are 225 eligible PCCs in the clinics randomized to the OUD-CDS. 
All randomized clinicians will be included in the analysis of Wizard use and 
prescribing and/or referral behavior (in event referrals are made to waivered 
clinicians).  
b. Inclusion and exclusion criteria. To be eligible for inclusion in this study, a PCC 
must practice at a study-eligible primary care clinic and be a family physician, general 
internist or adult-care non-obstetric nurse practitioner or physician assistant. PCCs 
are study-eligible regardless of whether they are waivered to prescribe 
buprenorphine. 
Sources or methods of recruitment. For the parent study, PCCs will have the 
opportunity to participate in a webinar about general training of the Opioid Wizard 
tool. This webinar will include information about CDS alerts, printing the PCC and 
patient priorities, and using the tool within Epic’s (EHR) active guidelines. At the end 
of the webinar, all eligible PCCs in intervention clinics will be notified about the 
opportunity to participate in additional case-based training on using Opioid Wizard, 
which they will receive an invitation to complete in their email. Up to three emails will 
be sent to PCCs from the MyLearning platform inviting them to participate in the 
training. The email will provide an introduction to the study and the elements of 
consent. We may also use additional strategies to encourage study participation, 
including asking clinic leaders to remind their PCCs to complete the training and 
directly emailing a final reminder before the initial survey closes. See Appendix A for 
recruitment email and Appendix B for the consent document. (Subsequent 
communications have been submitted separately as amendments.)  
PCCs who complete the initial training via MyLearning (either the stigma reduction 
training or the comparison [attention control]) will be emailed a follow-up survey 3 
months after they completed the initial training. PCCs will receive up to 4 emails to 
remind them to complete the follow-up survey. The recruitment email for the follow-
up survey is available in Appendix C. 
c. Incentives. PCCs will be offered a $100 gift card for completing the initial training 
and survey and a $25 gift card for completing the follow-up survey.  
 

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F. Allocation of interventions 
a. Methods for randomisation and stratification. PCCs in clinics randomized to Opioid 
Wizard (in 15 of the 30 clinics randomized in the parent study) will be randomized 1:1 
to the stigma reduction or comparison training, stratified by clinic and waiver status. 
Randomization will be generated using SAS software. 
b. Methods for concealment of allocation. PCCs will be blind to their randomized 
MyLearning training assignment. The study statistician (Dr. Crain) will generate the 
randomization assignment, and a study team member will submit that list to HP 
MyLearning staff. Study team members capturing outcome data from surveys, Opioid 
Wizard, and Epic (including use rates, buprenorphine prescriptions) will also be blind 
to treatment assignment. 
 
G. The Interventions 
a. Intervention delivery. Both the stigma reduction intervention and the comparison 
intervention will be delivered via MyLearning, an online learning platform that is 
available at HealthPartners. This training will be interactive, as PCCs will have the 
opportunity to participate in a case-based training on how to use the Opioid Wizard 
and will be able to click and interact with the training to demonstrate learning. 
b. Common intervention components in both trainings. General additional training 
in both groups will include science-based education about OUD and MOUDs and 
how to use Opioid Wizard, including where to review relevant chart history, making a 
diagnosis, choosing a treatment option, conducting follow-up, and caring for 
comorbid conditions. Medical record details relevant for providing care to four 
prototype patients at risk for or with OUD, such as age, gender, race/ethnicity, and 
comorbid conditions, will be presented to demonstrate aspects of the CDS.  
c. Stigma Reduction Training. Contact with a person sharing personal narratives 
(including a story of “on the way down” and “on the way up”) are the most powerful 
interventions to reduce public stigma of health conditions.38,39 For this study we have 
modified this approach for an online learning format. In addition to the training for 
Opioid Wizard described above, the stigma reduction intervention group will include 
patient narratives and recommendations for non-stigmatizing language. For example, 
one narrative is the story of a patient who developed OUD after taking opioids for an 
injury. PCCs will hear this patient story (e.g., a video of the “patient” (actor) telling 
their story embedded in the training), and the trainer will walk through how to use the 
CDS, including how to review relevant chart history, make a diagnosis, discuss 
treatment options, and conduct follow-up and care for comorbid conditions. The short 
narratives provide de-stigmatizing context and demonstrate CDS applicability to 
diverse populations, in addition to demonstrating aspects of the CDS.  
d. Comparison (Control) Training will include the general components as above but 
omits a stigma reduction component.40 This comparison training controls for 
attention, contact time and extra training on using Opioid Wizard. Participants will see 
the same cases that are presented in the Stigma Reduction Training, but they will not 
see the patient videos or hear the narratives. Instead, they will just see the EHR and 
the trainer will talk about the cases in generalities (e.g., “This is a patient who is 
coming in to the clinic who is at high risk for opioid use disorder.”).  
 
H. Outcome assessment  
a. Timing of outcome assessment. Immediately following training, PCCs will be 
asked to complete a brief (15-minute) follow-up survey via REDCap, a secure data 

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management software, to assess self-reported outcomes: stigma, waiver status, 
and, among non-waivered PCPs, intention to get waivered41 and intention to 
prescribe buprenorphine should a waiver no longer be required (see Appendix D). 
In addition, at 3 months following the training, PCCs will be asked to complete a 
follow-up survey via REDCap, to assess endurance of the stigma training on PCC 
stigma and intentions (see Appendix E). Opioid Wizard use will be pulled from CDS 
meta-data for each randomized clinician for encounters that are eligible for the  
Opioid Wizard intervention. PCC prescribing (number of MOUD, naloxone, and 
opioid prescriptions and the number of unique patients receiving prescriptions) and 
referral behavior will be extracted from the EHR. We will pull patient demographic 
information from the EHR to assess the extent to which provider behaviors differ 
across patient sub-groups, such as racial/ethnic groups, sex, and reason for 
intervention eligibility. 
b. Primary Outcome Measures 
i. OUD Stigma. Stigma of people with OUD will be measured using the Difference 
and Disdain scales, which measure stigma of people with mental illness and 
SUDs.11,12,42 This measure was chosen because people are more willing to state 
that people with a health condition are different from them than to endorse 
general stigmatizing beliefs, therefore reducing social desirability in stigma 
measurement.11 Three items measure difference (the extent to which a person 
with OUD is similar, like, or comparable to others) and three items measure 
disdain (people with OUD are not good, not respected, or not favorable 
compared to others). Items are scored on a 9-point agreement scale; some 
items are reverse-scored so that higher scores reflect greater difference and 
disdain. Evidence suggests that the scales demonstrate good internal 
consistency12 and are positively associated.18 In addition, three items will assess 
blame as a secondary outcome (e.g., How responsible do you think a person 
with opioid use disorder is for his or her condition?).43,44 
ii. Intentions to get waivered to prescribe buprenorphine. Non-waivered PCCs 
will be asked to rate one question on their intentions to get waivered to prescribe 
buprenorphine: “How likely are you to get waivered to prescribe buprenorphine 
in the next year?” PCCs will rate their response on a five-point Likert-type scale 
ranging from 1 (I definitely will not) to 5 (I definitely will). Behavioral intentions 
are commonly used proxies for behavior in behavioral science research and 
were chosen as the primary outcome for H1b and H2a because of the time it 
may take for a PCC to complete the waiver training, which may not occur during 
the study observation period (6-months post training). Across a wide range of 
behaviors, moderate-large changes in behavioral intentions are associated with 
small-moderate changes in behavior.45 
iii. Intentions to prescribe buprenorphine should a waiver no longer be 
required. Non-waivered PCCs will be asked to rate one question on their 
intentions to get waivered to prescribe buprenorphine: “If your patient with OUD 
requested buprenorphine in the next year and a waiver were no longer required, 
would you prescribe buprenorphine?”  PCCs will rate their response on a five-
point Likert-type scale ranging from 1 (I definitely would not) to 5 (I definitely 
would). We have added this question given recent press reports that the federal 
government is considering no longer requiring a waiver to prescribe 
buprenorphine for physicians. Even if this potential rule change does not go into 
effect during this study, press coverage of this potential change could influence 
clinicians’ intent to complete the waiver change (i.e., anticipating that soon it may 
no longer be required). The addition of this question provides a measure of intent 
to treat OUD with buprenorphine regardless of the waiver requirements at the 
time the question is answered. As noted above, moderate-to-large changes in 

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behavioral intentions are associated with small-to-moderate changes in 
behavior.45  
iv. Opioid Wizard Use. High use rates of Opioid Wizard are an important measure 
of PCC engagement. PCC Opioid Wizard use will be defined as taking action 
within the CDS tool, such as reviewing relevant chart history, screening for OUD, 
making a diagnosis, providing a referral or prescribing a medication, printing 
patient education materials, or prescribing naloxone. The use rates for each 
PCC for the follow-up period (6 months) will be calculated as the proportion of 
eligible visits in which Opioid Wizard was used. This provides an objective 
measure of PCC behavior with little social desirability bias. 
c. Secondary Outcome Measures 
i. Waivered PCC prescribing and referral behavior. As an exploratory outcome, 
we will gather the rate of MOUD, naloxone, and opioid prescriptions and 
referrals to waivered clinicians (primary care and specialty addiction medicine) 
among eligible patients in the 12 months prior to the study and during the 6-
month follow-up period to determine whether the stigma reduction and/or control 
training affected change in prescribing behavior. 
ii. PCC waiver status. In addition to intentions to get waivered, change in waiver 
status will be collected as an exploratory outcome. A list of waivered PCCs will 
be pulled from HP administrative data to determine if additional PCCs became 
waivered during the follow-up period. 
iii. PCC willingness to work with people with OUD. PCCs will report on their 
willingness to work with people with OUD using 3 items adapted from the Drug 
Problems Perceptions Questionnaire.46 PCCs will respond to each item using a 
5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). 
One item is reverse scored (“I would enjoy my job more if I could stop working 
with patients with opioid use disorder”) and the items will be averaged for a total 
score, with higher scores corresponding to greater willingness to work with 
people with OUD. 
iv. PCC opioid treatment outcome expectancies. Treatment outcome 
expectancies will be assessed using two items developed for this study. First, 
PCCs will rate the extent to which they believe available treatments are effective 
for treating OUD on a 4-point Likert-type scale ranging from 1 (not at all 
effective) to 4 (very effective). The second item will ask PCCs to rate the extent 
they believe patients will comply with those treatments on a 4-point Likert-type 
scale ranging from 1 (not at all likely) to 4 (very likely). Items will be analysed 
separately. 
v. PCC perceptions of the training and the Opioid Wizard tool. In the initial 
survey, PCCs will provide feedback on the training in four questions, including 
their perception of the usefulness and ease of use of the training and their 
intentions to use the Opioid Wizard tool. At the 3-month follow-up survey, these 
questions will be replaced with items specifically about Opioid Wizard, not the 
training, to assess likelihood of recommending Opioid Wizard to colleagues, 
frequency of using Opioid Wizard, Opioid Wizard ease of use, and intention to 
use Opioid Wizard in the future. 
d. Covariates 
i. Demographics. PCCs will report on their demographic characteristics, including 
gender, age, race, ethnicity, and days per week in clinic in the survey. 
HealthPartners administrative data will be used to determine clinician type 
(MD/DO, nurse practitioner, or physician assistant). 

12 
 
ii. Frequency in addressing OUD. PCCs will report on the frequency with which 
they typically address OUD in their practice using one item: How often do you 
treat patients with opioid use disorder? Response options will be on a 5-point 
Likert-type scale ranging from 1 (never) to 5 (daily). 
iii. PCC perceived vulnerability to OUD. PCC perceived vulnerability to 
developing OUD will be assessed using 3 items. PCCs will rate the extent they 
agree with each statement on a 5-point Likert-type scale ranging from 1 (strongly 
disagree) to 5 (strongly agree). One item will be reverse-scored (“If I were 
prescribed opioids, there is a real risk I would become addicted”). Items will be 
averaged for a total score, with higher scores corresponding to lower perceived 
vulnerability to OUD. 
 
I. Post-recruitment retention strategies 
a. Participant retention. To encourage PCCs to complete the training, they will receive 
up to 4 reminders and will be offered a $100 incentive. We may also ask clinic 
leaders to remind PCCs to complete training. Further, PCCs will be offered an 
additional $25 incentive for completing the follow-up assessment at 3 months. Direct 
email communications will be sent to request and remind them about the survey. 
There may be volunteer bias in those who complete the training; however, this 
should not compromise internal validity as factors that predict participation should be 
random across intervention assignment. We will describe differences between 
completers and non-completers (e.g., gender, PCC type, waiver status, clinic). 
b. Participant withdrawal. Participants may withdraw from the study at any time. It is 
possible that they will not complete the training or the surveys. However, the training 
and surveys are designed to be short so they do not overburden participants.  
 
J. Risks, benefits, safety monitoring and adverse events 
a. Risks to participants. This study involves minimal risk. The primary risk to PCCs is 
the risk of loss of confidentiality. However, the study team will take multiple steps to 
reduce those risks. First, each PCC will be assigned a unique study identification 
number. Their identifying information will be stored separately from their study data, 
and only the study team will have access to any linkage files. Those files will be 
stored on a secure, HealthPartners server only accessible by the study team, and will 
primarily be used to provide incentives to participants. Analytic data sets will not 
include any identifying information. 
b. Benefits. There are no direct benefits to participants in this study. However, the 
PCCs may find the training useful in helping them navigate Opioid Wizard, which 
could reduce frustration in learning a new EHR platform. One potential benefit is the 
knowledge of whether a training delivered via an online platform can incorporate 
patient narratives and ultimately reduce stigma among PCCs toward people with 
opioid use disorder, which has the potential to increase the availability of treatment in 
this population. 
c. Data and safety monitoring. Given the minimal risk involved in this study, a data 
and safety monitoring board (DSMB) is not indicated for this study. The parent trial 
has an independent DSMB appointed by the NIDA CTN that oversees that study. 
d. Adverse event reporting requirements. This is a minimal risk study. Adverse events 
and Serious Adverse events will not be collected in the context of this trial. 
 

13 
 
K. Data collection and management 
a. Data collection and management. Recruitment data will be stored in a protected 
project folder on a secure network drive. Surveys will be collected using REDCap, a 
secure data management software that stores data on internal HealthPartners 
servers. PCCs will get a link to the survey immediately after completing the training 
and will be instructed to fill out the survey in order to receive compensation for their 
time. PCCs will directly answer survey questions within the REDCap platform. For 
the follow-up survey, PCCs will receive an email and reminders at the time they are 
due for their follow-up. The email will have a link to the survey and PCCs will be able 
to directly answer the questions in the REDCap platform. Survey data will be 
accessed by study staff to determine which PCCs are eligible for incentives. 
Opioid Wizard use will be captured passively through the Opioid Wizard system, and  
prescriptions, referrals, and patient characteristics will be captured through the EHR. 
PCC Waiver status will be extracted from HealthPartners administrative data at the 
end of the study follow-up period. Data will be extracted by the study team and stored 
securely on the HealthPartners secure internal server. Patient data will be identified 
with a random unique identifier generated by the Wizard platform. The study 
programmer will use that information to pull data from the EHR. No MRNs or patient 
IDs will be retained in an analytic dataset.  
b. Quality control. Survey responses will be directly entered by participants into 
REDCap survey software. We will program REDCap to minimize non-viable or non-
allowable responses (e.g., limiting age to integers between 18 and 100). Participants 
will only be allowed to choose one Likert-type response on scale items. In addition, 
participants will be prompted to complete items that do not have a response, but will 
be allowed to leave them blank if they choose to do so. 
c. Progress reports. During study recruitment phases (initial training and follow-up 
survey), we will use REDCap reports to generate study completion rates and to 
prompt reminders to complete the training and surveys. The team will review the 
reports to determine if other strategies (e.g., reaching out to clinic leadership) are  
needed to boost recruitment and retention. 
 
L. Sample size 
There are 449 PCCs in the 30 clinics being considered for randomization to the parent 
study, COMPUTE 2.0, with an average of 15 per clinic (range 4-36). To the extent that 
the parent study will seek balance between treatment arms in clinic size, and by 
extension number of PCCs, we estimate that 225 PCCs will be in intervention clinics and 
eligible for this study. We have estimated power for PCC participation rates of 50%, 
65%, and 80% with equal numbers of PCCs per arm. Approximately 93% of PCCs at HP 
are not waivered, which would reduce available sample sizes for H1b and H1c to 208 
PCCs. The power analysis was calculated using G*Power 3.147 and determined the 
minimal detectable standardized effect between groups for each outcome given available 
sample size, α2 = .05, and desired power (see Table 1). Given these assumptions, we 
will have the ability to detect moderate differences (80% power: d = 0.42-0.55; RR=1.28-
1.58) between the groups. 
For Aim 2, the regression models will include PCCs in both arms and up to 4 covariates. 
Given sample size, α2 = .05, and desired power, we will have adequate power to detect 
small effects for H2a (80% power: f2 = 0.05-0.08) and moderate effects for H2b (80% 
power: RR=1.29-1.60). 
Table 1. Minimal detectable standardized effects based on PCC 
participation rate and desired power. 
PCC participation= 
50%  
65%  
80%  

14 
 
 
 
 
M. Analysis Strategies 
All variables will be examined using descriptive statistics and graphical methods to 
examine distributions, potential outliers, and analysis assumptions across and within 
study arms. The hypotheses predict that PCCs in the stigma reduction intervention will 
report less stigma of people with OUD and greater intentions to get waivered and 
prescribe buprenorphine (among non-waivered PCCs), and will use Opioid Wizard at a 
greater proportion of eligible encounters. A generalized linear model framework will be 
used to test the Aim 1 hypotheses, using appropriate error distributions and link functions 
to normalize outcomes. For H1a through H1c, the primary outcomes will be stigma (H1a) 
and intentions to get waivered (H1b) and to prescribe buprenorphine (H1c), assessed 
immediately following the training; as a secondary outcome, we will examine whether the 
intervention has enduring effects on stigma and intentions by examining differences 
assessed at the 3-month follow-up survey. Secondary analyses will include an 
interaction term between intervention arm and waiver status to assess treatment 
heterogeneity. 
In Aim 2, multiple linear regression models, controlling for PCC characteristics (i.e., age, 
gender, PCC type [physician, nurse practitioner, physician assistant], and waiver status 
[H2b only]) will be used to examine whether self-reported OUD stigma is related to (1) 
intention to get waivered to prescribe buprenorphine and (2) Opioid Wizard use. 
Secondary analyses will include an interaction term between stigma and waiver status to 
examine whether waiver status moderates the association between stigma and Opioid 
Wizard use. 
In secondary analysis, we will examine whether self-reported stigma mediates the effect 
of the intervention on Opioid Wizard use. If the intervention affects Opioid Wizard use 
(H1d), and stigma is related to Opioid Wizard use (H2b), we will use a product of 
coefficients approach to quantify how much of the intervention effect is mediated by 
stigma. In other exploratory analyses, we will examine whether PCCs in the stigma 
reduction arm prescribe MOUD and /or naloxone to eligible patients at a higher rate than 
PCCs in the comparison arm, controlling for pre-Opioid Wizard prescribing behavior. We 
will also examine whether PCCs in the stigma reduction arm prescribe opioids to eligible 
patients at a lower rate than PCCs in the comparison arm, controlling for pre-Opioid 
Wizard prescribing behavior. Further, as a follow-up to H1b, we will examine whether 
PCCs in the stigma reduction arm are more likely to get waivered than control PCCs 
using a logistic regression framework. To understand how PCC experience with patients 
at high risk for problems with opioids may have influenced their decision to participate in 
this study, we will compare PCC prescribing and referral behaviors among PCCs who 
completed the training to those who did not among all randomized PCCs. 
N. Ethical Aspects of RCTs 
a. Participant consent. At the beginning of the training module in MyLearning, PCCs 
will be given the consent form outlining the project, potential risks and benefits, and 
privacy and confidentiality protections. Participants will have the opportunity to review 
112 PCCs 
146 PCCs 
180 PCCs 
power = 
0.80 
0.90 
0.80 
0.90 
0.80 
0.90 
H1a: OUD Stigma 
d 
0.49 
0.57 
0.47 
0.54 
0.42 
0.49 
H1b, H1c: Intentions 
d 
0.55 
0.64 
0.48 
0.56 
0.44 
0.51 
H1d: CDS Use: 30% 
RR 
1.58 
1.69 
1.50 
1.59 
1.44 
1.52 
50% 
RR 
1.44 
1.51 
1.38 
1.44 
1.34 
1.39 
70% 
RR 
1.36 
1.43 
1.31 
1.37 
1.28 
1.33 
H2a: Intentions 
f2 
0.08 
0.10 
0.06 
0.08 
0.05 
0.06 
H2b: CDS Use: 30% 
RR 
1.60 
1.71 
1.52 
1.61 
1.46 
1.54 
50% 
RR 
1.45 
1.53 
1.39 
1.46 
1.35 
1.41 
70% 
RR 
1.37 
1.44 
1.32 
1.38 
1.29 
1.34 
Note. Cohen’s d = d; Cohen’s f2 = f2; Rate ratio = RR. 

15 
 
the consent form and provide consent by clicking a button: “I have read the above 
consent form and I agree to participate.” If participants have questions about consent 
or the project, they will be directed to contact the study principal investigator or 
project manager by email or phone. 
 
O. RCT Management 
a. Registering the trial. This study will comply with the NIH Data Sharing Policy and 
Policy on the Dissemination of NIH-Funded Clinical Trial Information and the Clinical 
Trials Registration and Results Information Submission rule. As such, this trial will be 
registered at ClinicalTrials.gov, and results information from this trial will be submitted 
to ClinicalTrials.gov. In addition, every attempt will be made to publish results in peer-
reviewed journals. 
b. Research governance and good clinical practice. Study staff are required to 
complete institutionally required training per their research site, IRB(s), and 
authorities with regulatory oversight. Training will include Human Subject Protection 
(HSP) and Good Clinical Practice (GCP), as well as protocol-specific training.  
 
P. Reporting, Dissemination and Notification of results  
a. Trial Registration. In keeping with NIH policy, this trial will be registered at 
ClinicalTrials.gov, and results information from this trial will be submitted to 
ClinicalTrials.gov.  
b. Publication policy. We will publish results in peer-reviewed journals.  The planning, 
preparation and submission of publications will follow the policies of the Publications 
Committee of the CTN. 
c. Disseminating results to the public. As a result of our previous and ongoing OUD 
and mental health research, we have established communication channels with key 
stakeholders in our health system, as well as with external stakeholders, including 
the NIDA CTN, the Mental Health Research Network, the Midwest Research 
Network, and the Health Care Systems Research Network. We anticipate that our 
findings will be of significant interest to these groups, and we will disseminate our 
findings, methods and resources. We will share our findings immediately through 
presentations at local and national meetings. We will publish our findings in peer-
reviewed journals and communicate our findings to public media outlets. 
d. Data Sharing. The study investigators will share a limited de-identified data set used 
for primary outcome analysis with NIDA for NIDA’s Data Share website. The CTN 
DSC can assist the study investigators with providing the data set to the designated 
party to ensure de-identification, and for posting, storing, and archiving on NIDA’s 
Data Share website. Data Share is an online repository of data from studies funded 
by the NIDA and is located at: https://datashare.nida.nih.gov/. In addition, we have 
partnered with Konadu Fokuo, PhD, an assistant professor in psychiatry at the 
University of Illinois at Chicago (UIC), who is interested in stigma of people with 
substance use disorders. We are finalizing a data transfer agreement with UIC, and 
Dr. Fokuo will be conducting secondary analyses on our data based on her interest in 
understanding how race/ethnicity interacts with stigma to affect willingness to treat 
people with OUD. 
 
 
 

16 
 
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EE. Social Stigma Toward Persons With Prescription Opioid Use Disorder: 
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Goodyear K, Haass-Koffler CL, Chavanne D. Opioid use and stigma: The role of 
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Corrigan PW, Nieweglowski K. Stigma and the public health agenda for the opioid 
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Wakeman SE, Rich JD. Barriers to Medications for Addiction Treatment: How Stigma 
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Olsen Y, Sharfstein JM. Confronting the stigma of opioid use disorder--and its 
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17 
 
22. 
Barry CL, Epstein AJ, Fiellin DA, Fraenkel L, Busch SH. Estimating demand for 
primary care‐based treatment for substance and alcohol use disorders. Addiction. 
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Fox AD, Masyukova M, Cunningham CO. Optimizing psychosocial support during 
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Framework: a global, crosscutting framework to inform research, intervention 
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van Brakel WH, Cataldo J, Grover S, et al. Out of the silos: identifying cross-cutting 
features of health-related stigma to advance measurement and intervention. BMC 
Med. 2019;17(1):13. 
32. 
Livingston JD, Milne T, Fang ML, Amari E. The effectiveness of interventions for 
reducing stigma related to substance use disorders: a systematic review. Addiction. 
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33. 
Nyblade L, Stockton MA, Giger K, et al. Stigma in health facilities: why it matters and 
how we can change it. BMC Med. 2019;17(1):25. 
34. 
Wakeman SE, Kanter GP, Donelan K. Institutional Substance Use Disorder 
Intervention Improves General Internist Preparedness, Attitudes, and Clinical 
Practice. J Addict Med. 2017;11(4):308-314. 
35. 
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of mental health first aid training in a diverse community setting. Int J Ment Health 
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36. 
Ballon BC, Skinner W. "Attitude is a little thing that makes a big difference": 
Reflection techniques for addiction psychiatry training. Academic Psychiatry. 
2008;32(3):218-224. 
37. 
Moore MD, Ali S, Burnich-Line D, Gonzales W, Stanton MV. Stigma, Opioids, and 
Public Health Messaging: The Need to Disentangle Behavior From Identity. Am J 
Public Health. 2020:e1-e4. 
38. 
Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rüsch N. Challenging the public 
stigma of mental illness: a meta-analysis of outcome studies. Psychiatric services. 
2012;63(10):963-973. 
39. 
Corrigan PW, Schomerus G, Shuman V, et al. Developing a research agenda for 
reducing the stigma of addictions, part II: Lessons from the mental health stigma 
literature. Am J Addict. 2017;26(1):67-74. 
40. 
Freedland KE, King AC, Ambrosius WT, et al. The selection of comparators for 
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18 
 
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process for providing translational research informatics support. Journal of 
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42. 
Corrigan PW, Shah BB, Lara JL, Mitchell KT, Simmes D, Jones KL. Addressing the 
public health concerns of Fetal Alcohol Spectrum Disorder: Impact of stigma and 
health literacy. Drug Alcohol Depend. 2018;185:266-270. 
43. 
Corrigan PW, River LP, Lundin RK, et al. Stigmatizing attributions about mental 
illness. Journal of Community Psychology. 2000;28(1):91-102. 
44. 
Corrigan PW, Rowan D, Green A, et al. Challenging two mental illness stigmas: 
Personal responsibility and dangerousness. Schizophrenia bulletin. 2002;28(2):293-
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19 
 
Appendix A: PCC Initial Recruitment Email 
 
Invitation letter to participate in a research study to be sent as an email from the MyLearning 
software. 
 
[date] 
Dear [Clinician Name], 
We are writing to you because we have received funding to implement a new clinical 
decision support system, Opioid Wizard, across several primary care clinics in the 
HealthPartners/Park Nicollet system.  In addition, we have received additional support to 
examine how two different versions of an online training, delivered via MyLearning, impact 
clinicians’ use of the tool and attitudes towards opioid use disorder. 
We invite you to participate in this study by completing one version of this online training and 
completing a survey immediately after completion. The training will take about 25-35 minutes 
to complete, and will walk you through 4 different patient scenarios in which you might use 
the Opioid Wizard. The training will demonstrate different features of the tool and help 
clinicians learn how to efficiently navigate Opioid Wizard. 
Immediately after the training, you will be given a link to complete a brief survey about your 
experience with the training and with working with patients with opioid use disorder. This 
survey should take 15 minutes or less to complete. You will receive a $100 gift card to 
Amazon for completing the training and the survey. 
Prior to completing the training in MyLearning, we will provide you with a complete 
explanation of the study and things you need to know before consenting to participate. You 
can click the link below to login to MyLearning and complete this training at any time.  
For more information, or to decline this invitation, you can email the study project manager, 
Amy LaFrance, MPH at amy.b.lafrance@healthpartners.com.  
 
Thank you for your consideration.  
 
 
 
Stephanie Hooker, PhD, MPH 
Principal Investigator 
Research Associate, HealthPartners Institute 
 
[LINK TO MYLEARNING TRAINING] 
 
 

20 
 
Appendix B: Consent Form 
 
Comparing Two Training Methods for Opioid Wizard 
CONSENT FORM 
Why is this study being done? 
The United States is in an opioid overdose crisis. Only a small percent of patients with opioid 
use disorder (OUD) get help.  As part of a larger study funded by the National Institute for 
Drug Abuse, we are examining the impact of two different versions of a training for Opioid 
Wizard on clinicians’ use of the tool and attitudes towards opioid use disorder.  
 
We are asking you to participate because you are a clinician who practices at a primary care 
clinic. Up to 225 primary care clinicians will participate in this study across 15 primary care 
clinics at HealthPartners and Park Nicollet. 
What will I be asked to do? 
You will be randomly assigned to receive version 1 of the Opioid Wizard training (Group A) 
or version 2 of the Opioid Wizard training (Group B). You will be asked to do the following: 
1. 
Complete a case-based training on how to use the Opioid Wizard tool in 4 different 
patient scenarios that should take 25 - 35 minutes 
2. 
Complete a 15-minute (online) survey on your experience with the training and attitudes 
towards opioid use disorder 
3. 
Complete a 15-minute follow-up (online)  survey in 3 months asking about your 
experience with the Opioid Wizard tool and your attitudes toward opioid use disorder 
What are the benefits? 
This study is not expected to help you. We hope that your participation will help us 
understand how to deliver better trainings for clinical decision support tools in the future.  
What are the risks? 
There are no physical risks expected with this study. There is a risk that your information 
could be seen by someone other than the study staff. We will take steps to protect your 
information.  
How is my information protected? 
Survey responses will be maintained in a secure location limited to study staff. The following 
groups may inspect these records:  
• 
National Institute on Drug Abuse and its partners 
• 
The Institutional Review Board of record  
• 
Applicable regulatory authorities 
 
No clinician-specific data will be shared with medical group leaders. 
 
Any information that can identify you will be removed before analysis.  The results of the 
study may be published. Your name or other personal information will never be used.   
Do I have to participate? 
Your participation is voluntary. Your decision to participate or to stop your participation at 
any time will not affect your relationship with HealthPartners. If you decide to participate and 
later decide you want to stop participating, please email Amy LaFrance at 
Amy.B.Lafrance@healthpartners.com at the email address below. 
 
Does this study cost me anything? Will I be paid? 
There will be no cost to you for participating in this research study. You will be given a $100 
Amazon gift card to complete the training and initial survey and a $25 Amazon gift card to 
complete the follow-up survey in 3 months. 

21 
 
Additional Information 
A description of this clinical trial will be available on http://ClinicalTrials.gov, as required by 
U.S. Law. This Web site will not include information that can identify you. At most, the Web 
site will include a summary of the results. You can search this Web site at any time. 
Data from this study will be available to researchers on another website, 
https://datashare.nida.nih.gov/ after the study is complete and the data analyzed. This 
website will not include information that can identify you.  
What if I have questions or problems? 
Call Stephanie Hooker, PhD, MPH at 952-967-5056 or email her at 
stephanie.a.hooker@healthpartners.com if you: 
• 
Have questions, concerns, or complaints about the survey.  
 
Call the HealthPartners Institutional Review Board (IRB) at 952-967-5025 if you: 
• 
Have questions about your rights as a research participant.  
• 
Have questions, concerns, or complaints about the research.  
 
You can also contact the HealthPartners IRB by mail at 8170 33rd Avenue South, Mail Stop 
21112R, Bloomington, MN 55440. Refer to study #A20-156. 
 
Statement of Consent: 
 
I have read the consent form and I understand: 
• 
What I am being asked to do, and  
• 
The risks and benefits of participating in this research  
 
I understand that clicking the “submit” button indicates: 
• 
I have read this consent form, 
• 
All my questions have been answered, and 
• 
I am agreeing to participate  
 
Please print or retain a copy of this consent for your records and return to the training 
module to consent and complete the training. 
 
 
 

22 
 
Appendix C: PCC Follow-up Survey Recruitment Email 
 
Invitation letter to participate in the follow-up survey to be sent as an email. 
 
[date] 
Dear [Clinician Name], 
We are writing to you because you completed a MyLearning training and a survey on Opioid 
Wizard three months ago, and we are hoping to get more feedback now that the tool has 
been in production for a few months. 
We invite you to participate in this brief, 15-minute survey about your experience with Opioid 
Wizard and with working with patients with opioid use disorder. You will receive a $25 gift 
card to Amazon for completing the survey. You can click the link below to complete the 
survey at any time.  
For more information, or to decline this invitation, you can email the study project manager, 
Amy LaFrance, MPH at amy.b.lafrance@healthpartners.com.  
 
Thank you for your consideration.  
 
 
Stephanie Hooker, PhD, MPH 
Principal Investigator 
Research Associate, HealthPartners Institute 
 
[LINK TO REDCap SURVEY] 
 
 

23 
 
Appendix D: Immediate Post Training Survey 
 
EXPERIENCE WITH THE OPIOID WIZARD TRAINING 
1. This training on Opioid Wizard will help me improve my practice. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
2. This training on Opioid Wizard helped me better understand how to use it. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
3. I found this training on Opioid Wizard easy to understand. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
4. How likely are you to use Opioid Wizard during clinic visits with patients who are 
thought to be at high risk for opioid use disorder or overdose? 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
WAIVERS AND INTENTIONS 
5. Are you currently waivered to prescribe buprenorphine/Suboxone? 
a. YES 
b. NO 
 
5a. [If NO] Do you intend to get waivered to prescribed buprenorphine in the next year? 
I definitely will 
not 
I likely will not 
Unsure 
I likely will 
I definitely will 
1 
2 
3 
4 
5 
 
5b. If a patient with OUD requested buprenorphine in the next year and a waiver were no 
longer required, would you prescribe buprenorphine?   
I definitely 
would not 
I likely would 
not 
Unsure 
I likely would 
I definitely 
would 
1 
2 
3 
4 
5 
 
 
5c. [If YES] What is your buprenorphine waiver patient limit? 
• 
30 
• 
100 
• 
275 
• 
Don’t know 
 
6. How often do you treat patients with opioid use disorder? 
Never 
A few times a 
year 
Once or twice 
a month 
Once or twice 
a week 
Daily 
1 
2 
3 
4 
5 
 
 
 

24 
 
 
 
 
 
 
 
DIFFERENCE, DISDAIN, & BLAME SCALE 
7. How similar or different do you think a person with opioid use disorder is compared to 
everyone else in the general population? 
Very 
similar to 
others 
 
 
 
 
 
 
 
Not at 
all 
similar 
to 
others 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
8. How good or bad you think a person with opioid use disorder is compared to 
everyone else in the general population? 
Very 
good 
 
 
 
 
 
 
 
Not at 
all 
good 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
9. How responsible do you think people with opioid use disorder are for their illness? 
Not at all 
responsible 
 
 
 
 
 
 
 
Very 
responsible 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
10. How like or unlike do you think a person with opioid use disorder is compared to 
everyone else in the general population? 
Very 
much 
like 
others 
 
 
 
 
 
 
 
Not at 
all like 
others 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
11. How respected or disrespected do you think a person with opioid use disorder is 
compared to everyone else in the general population? 
Very 
respected 
 
 
 
 
 
 
 
Not at all 
respected 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
12. How blamed do you think are people with opioid use disorder for their illness? 
Not at all 
blamed 
 
 
 
 
 
 
 
Very 
blamed 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
13. How comparable or not comparable do you think a person with opioid use disorder is 
compared to everyone else in the general population? 
Not at all 
comparable 
to others 
 
 
 
 
 
 
 
Very 
comparable 
to others 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 

25 
 
14. How favorable or unfavorable do you think a person with opioid use disorder is 
compared to everyone else in the general population? 
Not at all 
favorable 
 
 
 
 
 
 
 
Very 
favorable 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
15. How much do people with opioid use disorder cause their illness? 
Did 
cause 
their 
illness 
 
 
 
 
 
 
 
Did 
not 
cause 
their 
illness 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
PHYSICIAN VULNERABILITY 
16. If I were prescribed opioids, I am confident I could take them and not become 
addicted. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
17. If I experienced urges to continue opioid use after being prescribed an opioid, I would 
not give in to them. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
18. If I were prescribed opioids, there is a real risk I would become addicted. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
WILLINGNESS TO WORK WITH PEOPLE WITH OUD 
19. I would enjoy my job more if I could stop working with patients with opioid use 
disorder. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
20. I want to work with people with opioid use disorder. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
21. In general, it is rewarding to work with people with opioid use disorder. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
TREATMENT FUTILITY 
22. In your opinion, how effective are available methods for treating opioid use disorder? 
Not at all effective 
Somewhat effective 
Moderately 
effective 
Very effective 
1 
2 
3 
4 

26 
 
 
23. In your opinion, how likely are patients with opioid use disorder to comply with 
treatment recommendations? 
Not at all likely 
Somewhat likely 
Moderately likely 
Very likely 
1 
2 
3 
4 
 
 
DEMOGRAPHICS 
24. With what gender do you identify? 
a. Male 
b. Female 
c. Transgender male 
d. Transgender female 
e. Non-binary 
f. Not listed 
g. Prefer not to answer 
 
25. What is your age? ___________ 
 
26. Do you consider yourself to be Hispanic/Latino? 
o No 
o Yes 
 
27. If “Yes”, indicate the group that represents your Hispanic origin or ancestry (check all 
that apply): 
o Puerto Rican 
o Dominican (Republic) 
o Mexican/Mexican American 
o Chicano 
o Cuban/Cuban American 
o Central or South American 
o Other Latin American 
o Other Hispanic or Latino 
o Don’t know 
o Prefer not to answer 
 
28. What race do you consider yourself to represent? (Check all that apply) 
o American Indian or Alaska Native 
o Asian 
o Black or African American 
o Native Hawaiian or Pacific Islander 
o White 
o Some other race (specify): 
o Don’t know 
o Prefer not to answer 
 
29. On average, how many days a week do you see patients in clinic?  
o 0 
o 1 
o 2  
o 3 
o 4 or more 
 
 

27 
 
Appendix E: 3-month Follow-up Survey 
 
EXPERIENCE WITH OPIOID WIZARD  
 
1. Have you ever used Opioid Wizard? 
• 
No 
• 
Yes 
 
If NO, SKIP to question 5. 
 
2. How likely are you to recommend Opioid Wizard to a colleague? 
Not at all likely 
Not very likely 
Somewhat 
likely 
Moderately 
likely 
Very likely 
1 
2 
3 
4 
5 
 
3. How often do you use Opioid Wizard when a patient has been identified as being at 
risk for OUD or overdose within the EHR by the Opioid Wizard? 
• 
Not applicable; I have not had patients identified as at risk for OUD or 
overdose 
• 
None of the time 
• 
Some of the time 
• 
Most of the time 
• 
Every time 
 
4. Opioid Wizard makes it easier to discuss OUD treatment options with patients. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
5. When alerted to patients at increased risk of OUD or overdose, how likely are you to 
use Opioid Wizard during clinic visits in the future? 
I definitely will 
not 
I likely will not 
Unsure 
I likely will 
I definitely will 
1 
2 
3 
4 
5 
 
WAIVERS AND INTENTIONS 
6. Are you currently waivered to prescribe buprenorphine/Suboxone? 
• 
YES 
• 
NO 
 
6a. [If NO] Do you intend to get waivered to prescribed buprenorphine in the next year? 
I definitely will 
not 
I likely will not 
Unsure 
I likely will 
I definitely will 
1 
2 
3 
4 
5 
 
6b. If a patient with OUD requested buprenorphine in the next year and a waiver were no 
longer required, would you prescribe buprenorphine?   
I definitely 
would not 
I likely would 
not 
Unsure 
I likely would 
I definitely 
would 
1 
2 
3 
4 
5 
 
6c. [If YES] What is your buprenorphine waiver patient limit? 
• 
30 

28 
 
• 
100 
• 
275 
• 
Don’t know 
 
 
7. How often do you treat patients with opioid use disorder? 
Never 
A few times a 
year 
Once or twice 
a month 
Once or twice 
a week 
Daily 
1 
2 
3 
4 
5 
 
DIFFERENCE, DISDAIN, & BLAME SCALE 
8. How similar or different do you think a person with opioid use disorder is compared to 
everyone else in the general population? 
Very 
similar to 
others 
 
 
 
 
 
 
 
Not at 
all 
similar 
to 
others 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
9. How good or bad you think a person with opioid use disorder is compared to 
everyone else in the general population? 
Very 
good 
 
 
 
 
 
 
 
Not at 
all 
good 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
10. How responsible do you think people with opioid use disorder are for their illness? 
Not at all 
responsible 
 
 
 
 
 
 
 
Very 
responsible 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
11. How like or unlike do you think a person with opioid use disorder is compared to 
everyone else in the general population? 
Very 
much 
like 
others 
 
 
 
 
 
 
 
Not at 
all like 
others 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
12. How respected or disrespected do you think a person with opioid use disorder is 
compared to everyone else in the general population? 
Very 
respected 
 
 
 
 
 
 
 
Not at all 
respected 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
13. How blamed do you think are people with opioid use disorder for their illness? 
Not at all 
blamed 
 
 
 
 
 
 
 
Very 
blamed 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
14. How comparable or not comparable do you think a person with opioid use disorder is 
compared to everyone else in the general population? 

29 
 
Not at all 
comparable 
to others 
 
 
 
 
 
 
 
Very 
comparable 
to others 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
15. How favorable or unfavorable do you think a person with opioid use disorder is 
compared to everyone else in the general population? 
Not at all 
favorable 
 
 
 
 
 
 
 
Very 
favorable 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
16. How much do people with opioid use disorder cause their illness? 
Did 
cause 
their 
illness 
 
 
 
 
 
 
 
Did 
not 
cause 
their 
illness 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
PHYSICIAN VULNERABILITY 
17. If I were prescribed opioids, I am confident I could take them and not become 
addicted. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
18. If I experienced urges to continue opioid use after being prescribed an opioid, I would 
not give in to them. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
19. If I were prescribed opioids, there is a real risk I would become addicted. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
WILLINGNESS TO WORK WITH PEOPLE WITH OUD 
20. I would enjoy my job more if I could stop working with patients with opioid use 
disorder. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
21. I want to work with people with opioid use disorder. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 
22. In general, it is rewarding to work with people with opioid use disorder. 
Strongly 
disagree 
Disagree 
Neutral 
Agree 
Strongly Agree 
1 
2 
3 
4 
5 
 

30 
 
TREATMENT FUTILITY 
23. In your opinion, how effective are available methods for treating opioid use disorder? 
Not at all effective 
Somewhat effective 
Moderately 
effective 
Very effective 
1 
2 
3 
4 
 
24. In your opinion, how likely are patients with opioid use disorder to comply with 
treatment recommendations? 
Not at all likely 
Somewhat likely 
Moderately likely 
Very likely 
1 
2 
3 
4