Retention and Re-Engagement in Treatment for Addiction following Serious Injection Related Infections (RETAIN)

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PROJECT SUMMARY Serious injection-related infections (SIRIs), including infective endocarditis, bacteremia, osteomyelitis, epidural abscess, and septic arthritis have more than doubled since 2002 due to the opioid epidemic, causing morbidity, mortality, and costing more than $700 million annually. Growing evidence suggests that medications for opioid use disorder (MOUD) which include methadone, buprenorphine, and extended-release naltrexone reduce readmission and death following SIRIs. In response to this emerging data, programs and studies seek to optimize MOUD initiation in hospitals. However, the benefits of MOUD have not been fully realized due to limited retention in treatment with MOUD after hospitalization. To date, there has been a paucity of research focused on MOUD retention, the crucial next step of the opioid use disorder (OUD) care continuum. Further, evidence-based MOUD retention interventions have not been adapted for individuals with SIRIs who have riskier injection practices, greater medical complexity, mortality, and costs than others with OUD. The Recovery Management Checkups model is a proactive, peer-delivered, motivational interviewing-based MOUD retention intervention that increased retention by 50% in outpatient addition treatment and following incarceration. It has been piloted in multiple settings, making it a promising intervention for individuals with SIRIs who face unique challenges following their infections. Therefore, the central objective of this proposal is to determine individual and group factors associated with MOUD treatment along the OUD care continuum in the critical 12 month period after a SIRI and to use these insights to adapt and test Recovery Management Checkups for this new population. This proposal includes three aims: 1) Examine MOUD treatment along the OUD care continuum in the 12 months after SIRIs; 2) Informed by the findings from Aim 1, adapt the Recovery Management Checkups MOUD retention model for individuals with SIRIs; 3) Conduct a pilot randomized controlled trial of the adapted intervention to promote MOUD retention and re-engagement for individuals with SIRIs. The findings from these Aims address a gap in current research and will inform care for individuals with SIRIs, a priority area for the National Institute on Drug Abuse. Dr. Kimmel, an early-career investigator is the PI and will use this Career Development Award to develop skills in modeling approaches to address recurrent events (e.g. multiple treatment episodes) and group membership (e.g. latent classes) in treatment retention data, qualitative methods, intervention adaptation and development, and clinical trials design. Developing these skills will position him to lead impactful research that will improve the care and outcomes for very high- risk individuals who use drugs. Dr. Kimmel will work closely with a mentorship and advisory team with experience in addiction medicine, infectious diseases, biostatistics, qualitative methods, intervention adaptation and development and clinical trials to accomplish his research and training Aims.