Counseling for Harm Reduction and Retention in Medication-assisted treatment - Cherokee Nation (CHaRRM-CN)

药物辅助治疗中减少伤害和保留的咨询 - Cherokee Nation (CHaRRM-CN)

• 批准号: 9978800
• 负责人: Susan E Collins
• 金额: $ 58.91万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9978800
• 关键词: Abstinence; Address; Alcohol or Other Drugs use; American Indians; Biochemical; Centers for Disease Control and Prevention (U.S.); Cherokee Indian; Cognitive Therapy; Communities; Counseling; Data; Development; Emergency department visit; Evaluation; Focus Groups; Foundations; Funding; General Population; Goals; Gold; Harm Reduction; Health Services; Health system; High Prevalence; Individual; Interview; Length; Medical; Methods; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Participant; Patient Self-Report; Patients; Phase; Population; Positioning Attribute; Professional counselor; Provider; Proxy; Public Health; Relative Risks; Research; Research Methodology; Research Personnel; Services; Suboxone; Substance Use Disorder; Treatment outcome; United States Substance Abuse and Mental Health Services Administration; Universities; Washington; Work; arm; comparative efficacy; efficacy testing; evidence base; experience; flexibility; follow-up; illicit opioid; improved; medication-assisted treatment; mortality; opioid epidemic; opioid mortality; opioid overdose; opioid use; opioid use disorder; overdose death; patient oriented; primary outcome; programs; response; retention rate; secondary outcome; self reliance; systematic review; treatment as usual; tribal community

ABSTRACT American Indians (AIs) are disproportionately impacted by the current opioid epidemic. AIs experience an 88% higher prevalence of OUDs (1.5%) than the US general population (0.8%), and AIs are second only to non-Latinx whites in their experience of opioid overdose deaths (13.9 and 17.5 per 100,000, respectively). Fortunately, medication-assisted treatment (MAT; e.g., buprenorphine + naloxone) is highly effective for reducing opioid- related harm, including overdose, making it the gold-standard OUD treatment approach. A recent systematic review, however, showed a median retention of 56% at the NIDA-recommended 12-month treatment length. Further, most AIs with OUD do not attend traditional substance-use treatment (62%). This is concerning because treatment retention is strongly associated with mortality rate reduction. Although no studies have documented OUD treatment outcomes specific to AIs, research in Native communities has generally highlighted concerns about the cultural acceptability of the highly directive, Western medical substance-use treatment approaches (e.g., cognitive-behavioral therapy, 12-step programming) that are widely available. Further, previous research has indicated that AIs with substance use disorders want greater representation of Native staff and better integration of culturally adapted approaches in the services they receive. Culturally adapted approaches to treatment are associated with reductions in use and associated problems. However, there are currently no evidence-based, culturally adapted counseling approaches for AIs addressing MAT retention and opioid-related harm. Accordingly, we propose a 2-phase R61/R33 development and evaluation project in response to RFA-DA- 19-013 - “Responding to Opioid Use Disorders (OUD) in Tribal Communities in the Context of SAMHSA and CDC Funding.” This project will leverage recent federal OUD treatment initiative funding (SAMHSA TI-18-016, CDC-RFA-OT18-18030101supp) as a platform for culturally adapting substance-use counseling focused on improving MAT retention and reducing opioid-related harm within the Cherokee Nation Health System (CNHS). The 2-year R61 Phase will entail 2 parts. First, we will conduct a mixed methods inquiry to inform research methods and the community-specific, cultural adaptation of an existing, efficacious, harm-reduction counseling approach. Second, we will manualize and pilot the resulting Counseling for Harm Reduction and Retention in MAT at Cherokee Nation (CHaRRM-CN) together with a community advisory board comprising CNHS providers, staff, and patients as well as researchers from Cherokee Nation, Washington State University, and the University of Washington. The subsequent, 3-year R33 Phase will entail a 2-arm RCT (N=160) conducted within CNHS testing the efficacy of CHaRRM-CN in improving 6-month MAT retention, reducing substance-related harm and illicit opioid use, and increasing Native enculturation compared to a services-as-usual control condition (i.e., cognitive behavioral treatment).

摘要 美国印第安人(AI)受到当前阿片类药物流行的不成比例的影响。AIS体验达到88% ODS的患病率(1.5%)高于美国总人口(0.8%)，人工智能仅次于非拉丁裔 白人在阿片类药物过量死亡方面的经验(每10万人中分别为13.9人和17.5人)。幸运的是， 药物辅助治疗(如丁丙诺啡+纳洛酮)对减少阿片类药物非常有效- 相关危害，包括服药过量，使其成为OUD的黄金标准治疗方法。最近的一次系统性的 然而，综述显示，在NIDA推荐的12个月治疗时间内，中位数保留率为56%。 此外，大多数患有尿毒症的人工授精患者没有接受传统的药物使用治疗(62%)。这令人担忧，因为 治疗保留与死亡率的降低密切相关。尽管没有研究证明 尽管针对AIS的治疗结果，土著社区的研究普遍强调了人们的担忧 关于高度指导性的西医物质使用治疗方法的文化可接受性 (例如，认知-行为疗法、12步计划)，这是广泛可用的。此外，之前的研究 已经表明，有药物使用障碍的认可机构希望更多的本地工作人员代表，并更好地 在他们所接受的服务中融入适应文化的方法。适应文化的方法 治疗与减少使用和相关问题有关。然而，目前还没有 AIS的循证、文化适应的咨询方法解决垫子滞留和阿片类药物相关问题 伤害。因此，我们提出了R61/R33两阶段开发和评估项目，以响应RFA-DA- 19-013-“应对部落社区的阿片类药物使用障碍(OUD) 疾病控制与预防中心的资金。该项目将利用最近的联邦OUD治疗计划资金(SAMHSA TI-18-016， CDC-RFA-OT18-18030101supp)作为文化适应物质使用咨询的平台，重点是 在切诺基国家卫生系统(CNHS)内改善垫子保留和减少阿片类药物相关危害。 为期两年的R61阶段将包括两个部分。首先，我们将进行一项混合方法的调查，以提供研究信息 一种现有的、有效的、减少伤害的咨询的方法和社区特有的文化适应 接近。第二，我们将对由此产生的减少伤害和保留伤害的咨询进行手册化和试点 Cherokee Nation的MAT(CHaRRM-CN)以及由CNHS提供者组成的社区咨询委员会， 工作人员、患者以及来自切诺基国家大学、华盛顿州立大学和该大学的研究人员 华盛顿的。随后为期3年的R33阶段将需要在CNHS内进行双臂RCT(N=160 测试CHaRRM-CN在改善6个月垫子固位率、减少物质相关伤害和 非法使用阿片类药物，与照常提供服务的控制条件相比，土著文化培养增加(即， 认知行为治疗)。