By checking this box you agree to participate in the study (you must check the box to continue): link .)
I agree to participate in this study
You must go back and check the box stating "I agree to participate in this study" before you can answer any questions. Thank you for your interest in our research study!
1. How old are you today?
* must provide value
age in years
2. Are you currently living within the United States?
* must provide value
Yes
No
3. Are you a resident from the state of Alabama, Nebraska, or Mississippi?
* must provide value
Yes, I am a resident from Alabama or Nebraska.
Yes, I am a resident from Mississippi.
No, I am not a resident of Alabama, Nebraska, or Mississippi.
Not asked
4. Which biological sex were you assigned at birth?
Female
Male
5. Which gender identity do you most identify with:
Female
Male
Gender non-conforming
Trans female/Trans woman
Trans male/Trans man
Prefer not to answer
6. Are you currently pregnant, or think you may be pregnant?
* must provide value
Yes
No
7. Where did you hear about this study?
* must provide value
University of Michigan-Michigan Medicine
Veterans Affairs (VA) Health System
Spectrum Health Services
Private doctor or buprenorphine clinic (please specify)
Outpatient substance use treatment clinic (e.g. Packard Health, Meridian Health Services, Gammons Medical) (please specify)
A flyer in a public place (please specify)
Website (e.g. InTheRooms.com) (please specify)
A friend or relative
Other (please specify)
Please specify private doctor or buprenorphine clinic:
Please specify outpatient substance use treatment clinic (e.g. Packard Health, Meridian Health Services, Gammons Medical) :
Please specify public place
8. Do you have consistent access to a telephone that you would be willing to use for study-related telephone sessions?
* must provide value
Yes
No
1. On a scale of 0-10, with 0 being no pain at all and 10 being the worst possible pain, how would you rate your average pain during the PAST 3 MONTHS?
* must provide value
0 No pain at all
1
2
3
4
5
6
7
8
9
10 Worst possible pain
2. On a scale of 0-10, with 0 being no pain at all and 10 being the worst possible pain, how would you rate your worst pain during the PAST 3 MONTHS?
* must provide value
0 No pain at all
1
2
3
4
5
6
7
8
9
10 Worst possible pain
1. Do you have a current prescription for buprenorphine from a doctor, or are you planning to start treatment soon?
* must provide value
Yes, I have a current prescription from a doctor
Not yet, but planning to start treatment and get a prescription within the next week
No, I don't have a current prescription from a doctor
2. What form of buprenorphine are you currently taking?
* must provide value
Tablets/ pills / films
Patch (Butrans)
Injection (Sublocade)
I don't have a current prescription / have not started treatment yet
Yes No
Yes No
Was the methadone prescribed?
* must provide value
Yes No
Yes No
Was the buprenorphine prescribed?
* must provide value
Yes No
d. Other opioid analgesics (e.g. morphine, Oxycontin, oxycodone, hydrocodone, Vicodin, Percocet, Dilaudid, tramadol)
Yes No
Were the opioid analgesics prescribed?
Yes No
2. Did you ever need to use more opioids to get the same feeling (pain relief/high) as when you first started using opioids?
* must provide value
Yes No
3. Did the idea of missing a dose ever make you anxious or worried?
* must provide value
Yes No
4. In the morning, did you ever use opioids to keep from feeling sick or did you ever feel sick when you hadn't taken any opioids for a while?
* must provide value
Yes No
5. Did you worry about your use of opioids?
* must provide value
Yes No
6. Did you find it difficult to stop or not use opioids?
* must provide value
Yes No
7. Did you ever need to spend a lot of time/energy on finding opioids or recovering from taking them?
* must provide value
Yes No
8. Did you ever miss important things like doctor's appointments, family/friend activities, or other things because of opioids?
* must provide value
Yes No
View equation View equation Great! It looks like you may be eligible to take part in the Persist Study. The purpose of the study is to learn if new programs will help patients develop new strategies for managing their pain and medications. If you decide to join, you can earn up to $500 in gift cards over the next year. To determine your full eligibility, we would like to schedule an appointment with you.
Yes
No
Thank you! Please fill out the information below so we can contact you to schedule an appointment. Your contact information will only be used by the Persist Study and will not be shared with anyone.
Thank you for your time!
First name:
* must provide value
Last name:
* must provide value
Your email address:
* must provide value
Your cell phone number:
* must provide value
Date of birth (MM/DD/YYYY):
* must provide value
Today M-D-Y
How would you like us to contact you?
* must provide value
Email
Phone call
Text
Other
Other (please specify):
* must provide value
E1. Pt is under 18 years of age
E2. No OUD diagnosis in 12 months
E3. No Buprenorphine in 6 months
E4. No pain within 3 months
E5. Pt does not have consistent telephone access
E6. Pt cannot provide consent
E7. Pt is currently pregnant
E8. Pt unable to speak English
You must double check that this participant has or is getting a buprenorphine prescription, and/or that they are currently taking/will be taking it within the next week before they can be deemed "eligible."
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