Increasing the uptake of medication-assisted treatment for opioid use disorder

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PROJECT SUMMARY The goal of this K23 Mentored Patient-Oriented Research Career Development Award is to support the applicant in developing the critical skills necessary to become an expert in implementing evidence-based treatments for substance abuse disorders in community settings. This K23 application proposes research to address Objective 3.4 of the NIDA Strategic Plan: Develop and test strategies for effectively and sustainably implementing evidence-based treatments, specifically identifying factors that influence effective and sustainable dissemination and implementation of evidence-based practices for treatment of substance use disorders and improving access to effective addiction interventions. The mentorship team comprises an academic-public partnership that combines clinical, academic, and public system expertise in Kyle Kampman, MD, Geoff Neimark, MD, and a team of advisors. The specific trainings goals are to 1) Gain an in-depth knowledge of the organization, financing, and delivery of community substance abuse treatment for opioid use disorder, specifically as it relates to medication-assisted treatment, 2) Use theory-based approaches to identify specific organizational, practitioner and policy-level factors that could be leveraged to increase implementation of MAT in community settings; and 3) Develop expertise in designs and methods for conducting randomized trials of organizational strategies to increase the use of MAT in community settings, which will include: a) theory-based hybrid multi-level effectiveness-implementation research designs and b) analysis of administrative (claims-based) data to measure relevant outcomes. The research proposed in this K23 will focus on agencies that have not previously adopted MAT. Prior research and our pilot data suggest two categories of MAT non-adopters: those whose barriers are primarily ideological/attitudinal and those whose barriers are largely practical/logistical. The goal of the proposed study is to investigate both categories of barriers among community providers, and to develop a resource package to support future initiatives to enhance MAT capacity. Specifically, the applicant proposes to: 1) Determine what organizational factors and characteristics of executive directors are associated with a substance use disorder treatment organization’s (n = 117) decision to adopt in response to a policy incentivizing MAT adoption, 2) Evaluate the implementation success of the subset of agencies who adopt MAT in response to the initiative, identifying malleable organizational and psychological factors that lead to successful implementation and 3) Develop a resource package of MAT adoption and implementation strategies using established tools and identifying new areas for future research and exploration. Over the course of this project the applicant will develop critical knowledge and skills in community addiction treatment, implementation science, and public policy, with the expertise of an experienced and established team of mentors.