ACTION: Trial of Adding Buprenorphine, CBT, and TMS to Improve Outcomes of Long-Term Opioid Therapy for Chronic Pain

Exclusion Criteria14

• Known allergy to buprenorphine
• Active moderate or severe substance use disorder with the exception of those listed below:
• . Those with nicotine use disorder.
• . Those meeting criteria for prescription opioid use disorder using only prescribed opioids will be considered on a case-by-case basis.
• Cognitive disorder limiting ability to consent or fully participate in the brief cognitive intervention
• Receiving methadone or buprenorphine treatment for OUD or pain
• Taking naltrexone
• Pregnancy
• Currently incarcerated
• Taking medications that prolong QTc interval, as determined by study investigators
• Personal/immediate family history of Long QT Syndrome.
• Significant or unstable condition/s or treatments that may impact safe participation in the study (as determined by the study investigators) such as significant cardiac condition (e.g. poorly-controlled heart failure, current or past cardiac arrhythmia, sustained systolic blood pressure >180), significant metabolic disorder (e.g. labile diabetes, significant electrolyte abnormality), cancer (e.g. brain cancer, chemotherapy-induced cognitive impairment), major psychiatric disorder (e.g. active bipolar disorder, schizophrenia spectrum or other psychotic disorder, suicidal/homicidal intent within the past month, or any suicide attempts within the past year or current active suicidal ideation, as determined by medical clinician), developmental disorder (e.g. autism spectrum disorder, intellectual disability), or other neurologic disease (e.g. movement disorder, multiple sclerosis, moderate to severe brain injury).
• Enrolled in a clinical trial or has received an investigational medication or device in the last 30 days.
• TMS contraindications (e.g., ferromagnetic implants, conditions or treatments that lower seizure threshold, taking contraindicated medications, no identifiable motor threshold, as determined by study investigators).