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

早在2020年2月，美国印第安人和阿拉斯加原住民（AI/AN）社区就开始报告 与美国其他地区相比，COVID-19的患病率有所上升。与非新住户工作者（21%）相比， 的AI/AN成年人患COVID-19相关严重疾病的风险最大。AI/AN成年人也更有可能 患有潜在的健康状况，进一步增加了对COVID-19感染的脆弱性，例如 糖尿病、心血管疾病和癌症。历史和政治因素加剧了这些风险 因素，包括天花和西班牙流感造成的人口崩溃， 印度卫生服务的现状、获得所需护理的障碍以及长期资金不足。到 生动地说明了COVID-19相关的差异，AI/AN人占新墨西哥州人口的11%，但 占该州COVID-19病例的55%以上，10纳瓦霍族报告确诊3，912例 140例死亡（截至2015年5月21日）。为了满足物质使用障碍患者的治疗需求， 特别是阿片类药物使用障碍（OUD），在COVID-19紧急情况下，联邦法规指导成瘾 服务的提供已经修改，包括在人工智能/人工智能社区内。变化包括扩展 远程医疗和虚拟行为健康服务，调整OUD的药物剂量策略， 改变成瘾服务的报销和保密政策和做法。虽然这些政策 转变是为了促进可用性和访问，对采用，实施和 这些变化在服务于AI/AN社区的计划中的有效性。迫切需要数据来提供信息 COVID-19紧急情况后的政策决定-也就是说，是否应进一步制定政策， 扩展或可选地回滚。为了确保未来有关戒毒服务的政策决定 包括AI/AN社区的经验和需求，对传播、采用和 在AI/AN服务成瘾治疗计划中实施联邦成瘾政策至关重要 重要性本研究的目标是迅速调查传播，采用，实施， 部落社区中维持物质使用和与COVID-19相关的政策变化。 具体目标是评估COVID-19的传播、采用和实施情况， 19政策和法规在部落，州，和联邦各级，包括定量问题， CTN 0096 -1a全国部落成瘾调查（n=300），并检查 通过定性访谈了解部落、州和联邦层面的COVID-19政策和法规变化 在供应商和消费者之间进行（n=50）。

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).