Opioid tapering counseling with tizanidine to reduce opioid use and pain after surgery

You may qualify if

• 18 to 75 years of age
• Able to speak, write, and read fluently in English
• Scheduled for elective surgery at; Stanford University Medical Center,; Brigham and Women's Hospital (Harvard University),; Atrium Health Wake Forest Baptist Medical Center (Wake Forest University), or; University of Kansas Medical Center
• Preoperative long-term opioid use (Defined as ≥ 60-day supply of opioids in the 180-day period prior to surgery), identified via self-report, state Prescription Drug Monitoring Program (PDMP), or Electronic Medical Records (EHR). Days may be nonconsecutive, and actual use of opioid supply is not required.
• Willing and able to complete online assessments and study calls independently
• On the preoperative Baseline assessments, least one of the following:; Current Opioid Misuse Measure (COMM-17): score ≥ 9; Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS-1): Reported use more frequent than "Never" on any item except Tobacco; for Tobacco, "Yes" to at least one item on the TAPS-2 for Tobacco; Alcohol Use Disorders Identification Test (AUDIT-C): score ≥4 (men), ≥3 (women); Modified Brief Pain Inventory (mBPI): "Yes" to at least one of the following:; Over the past 24 hours have you needed to take your pain medication to help you sleep?; Have you taken any pain medications for any reason other than your pain, such as to reduce anxiety or improve mood?; Have you taken more pain medication than was prescribed to you in the past 24 hours?
• At the Post-Operative Call (7-13 days post-op): Postoperative daily opioid dose ≥ preoperative daily opioid dose (identified during the Pre-Surgery Call 5-1 day before surgery), measured in Morphine Milligram Equivalents (MME).

You can't join if

• Infection, tumor, or fracture at the operative site
• Allergy or intolerance to tizanidine
• Current use of tizanidine
• Renal impairment (Creatinine Clearance [CrCl] < 25 ml/min)
• Hepatic impairment, including cirrhosis or elevated liver enzymes
• Concurrent use of other α2-adrenergic agonists, skeletal muscle relaxants
• Concurrent use of: fluvoxamine, ciprofloxacin,zileuton, fluoroquinolones, antiarrhythmics (amiodarone, mexiletine, propafenone, verapamil), cimetidine, famotidine, oral contraceptive pills, acyclovir, ticlopidine, and fexinidazole
• Pre-existing hypotension, sedation, dizziness, severe respiratory insufficiency.
• Opioid Use Disorder
• Suicidality as assessed by the Patient Health Questionnaire-9 (PHQ-9) Question 9 score ≥ 1
• Pregnancy, breastfeeding, or planning to conceive
• Planned cancer treatment in the < 3 months following surgery
• Conditions causing inability to complete assessments (education, cognitive ability, mental status, medical status)
• Participating in another clinical trial with an active treatment arm