New Mexico Clinical Trials Node: Clinical research and practice to address substance use in diverse, rural and underserved populations

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As early as February of 2020, American Indian and Alaska Native (AI/AN) communities began to report increased prevalence rates of COVID-19 relative to the rest of the US. Compared to non-NHWs (21%), 34% of AI/AN adults are at greatest risk of COVID-19 related serious illness. AI/AN adults are also more likely to suffer from underlying health conditions that further increases vulnerability to COVID-19 infection, such as diabetes, cardiovascular disease, and cancer. These elevated risks are exacerbated by historical and political factors, including population collapses from smallpox and the Spanish flu, low socioeconomic status, obstacles to accessing needed care and chronic underfunding of the Indian Health Service. To vividly illustrate COVID-19-related disparities, AI/AN people comprise ~11% of the New Mexico population, yet account for more than 55% of COVID-19 cases in the state,10 with the Navajo Nation reporting 3,912 confirmed cases and 140 deaths (as of 5/21/20). To address the treatment needs of people with substance use disorders, especially opioid use disorder (OUD), during the COVID-19 emergency, federal regulations guiding addiction services delivery have been modified, including within AI/AN communities. Changes include expansion of telemedicine and virtual behavioral health delivery, adjusting medication dosing strategies for OUD, and altering reimbursement and confidentiality policies and practices for addiction services. Although these policy shifts were to promote availability and access, little is known about the adoption, implementation, and effectiveness of these changes among programs serving AI/AN communities. Data is critically needed to inform policy decisions following the COVID-19 emergency – that is, should policies be further developed and expanded or, alternatively, rolled back. In order to ensure future policies decisions about addiction service include experiences and needs of AI/AN communities, rapid research on the dissemination, adoption, and implementation of federal addiction policies among AI/AN-serving addiction treatment programs is of vital importance. The goal of this study is to rapidly investigate the dissemination, adoption, implementation, and sustainment of substance use and COVID-19 related policy changes among Tribal communities. The specific aims are to assess the dissemination, adoption, and implementation of COVID- 19 policy and regulations at Tribal, State, and Federal levels by including quantitative questions to the CTN0096-1a National Tribal Addiction Survey (n=300) and examine the implementation and outcomes of COVID-19 policy and regulation changes at the Tribal, State, and Federal levels through qualitative interviews conducted among providers and consumers (n=50).