Increasing Peer Support for OUD Recovery during COVID-19 through Digital Health: A National Randomized Controlled Trial

项目摘要 在COVID-19大流行期间，观察到阿片类药物过量的人数越来越多，这可能反映了 这场流行病对本已脆弱的人群的多重影响。从阿片类药物使用障碍中康复的人 (OUD)报告了不成比例的心理社会痛苦和孤立，以及 在2019冠状病毒病大流行期间获得治疗，包括同伴支持。这些负面结果是 对于从OUD中恢复的农村，低收入和少数民族人口尤为严重。同伴的支持是关键 许多循证OUD康复计划的组成部分：它提高了康复资本，改善了治疗 参与，改善感知的社会支持，并减少心理社会困扰，特别是当用于 结合其他循证治疗，如阿片类药物使用障碍（MOUD）。这 因此，在对PA 20-237的回应中提交的一项赠款提出了一项新的移动的 在1300名阿片类药物使用障碍康复患者的全国样本中， （OUD），作为常规护理的辅助。我们以前试点的网上招聘和跟踪- 向上策略-我们将患者报告的结果与管理数据集融合在一起-允许战略性 招募来自美国各地的经常被排除在外的参与者，包括那些面临最高风险的参与者。 治疗的障碍。基于移动的应用程序的同伴支持干预，作为个人级别提供 加强现有的治疗和康复计划，将使OUD康复中的个人能够获得 量身定制匿名同行主持的全天候支持小组该应用程序使用自然语言进行增强 处理工具能够自动“标记”关键或临床相关内容，从而创建一个 可扩展的系统，以保持群体的安全和建设性。参与者将被随访6个月， 自我报告和行政成果。这项研究的主要结果是自我报告的恢复资本， 辅以客观衡量的管理数据，从我们的治疗方案保留 社区和政府合作伙伴的650名患者的子样本从RI和IN。假想中学 结果是减轻COVID-19对这一弱势群体的心理社会影响，包括抑郁症 症状、压力和孤独，以及急诊科就诊和阿片类药物的客观不良事件 吸毒过量最后，我们将探讨州和县一级变量是否适度的功效。重要性： OUD是一个主要的公共卫生问题，从OUD中恢复的患者正在经历更糟糕的结果 2019冠状病毒大流行期间。如果这个移动的应用程序在一个大的国家样本中证明了功效， 患者，它有可能扩大现有的治疗方案，提高恢复资本，并减少 COVID-19对这一弱势群体的影响不成比例。

PROJECT SUMMARY Increasing numbers of opioid overdoses have been observed during the COVID-19 pandemic, likely reflecting the pandemic’s multiple effects on this already vulnerable population. People in recovery from opioid use disorder (OUD) have reported disproportionate psychosocial distress and isolation, as well as significant disruptions in access to treatment including peer support, during the COVID-19 pandemic. These negative outcomes are especially acute for rural, low-income, and minority populations in recovery from OUD. Peer support is a key component of many evidence-based OUD recovery programs: it improves recovery capital, improves treatment engagement, improves perceived social support, and reduces psychosocial distress, particularly when used in conjunction with other evidence-based treatments such as medication for opioid use disorder (MOUD). This grant, submitted in response to PA 20-237, therefore proposes a randomized controlled trial of a novel mobile peer support app platform among a national sample of 1300 patients in recovery from opioid use disorders (OUDs), as an adjunct to usual care, during COVID-19. Our previously piloted online-only recruitment and follow- up strategy – in which we meld patient-reported outcomes with administrative datasets – allows strategic recruitment of often-excluded participants from across the United States, including those facing the highest barriers to treatment. The mobile app-based peer support intervention, provided as an individual-level enhancement of existing treatment and recovery programs, will allow individuals in OUD recovery to access a tailored, anonymous, peer-moderated support group 24/7. The app is augmented with natural language processing tools capable of automatically ‘flagging’ critical or clinically relevant content, thereby creating a scalable system to keep groups safe and constructive. Participants will be followed for 6 months through both self-report and administrative outcomes. The study’s primary outcome is self-reported recovery capital, complemented by objectively measured administrative data on retention in treatment programs from our community and governmental partners in a sub-sample of 650 patients from RI and IN. Hypothesized secondary outcomes are mitigation of psychosocial effects of COVID-19 on this vulnerable population, including depressive symptoms, stress, and loneliness, as well as objective adverse events of emergency department visits and opioid overdoses. Finally, we will explore whether state- and county-level variables moderate efficacy. SIGNIFICANCE: OUD is a major public health problem, and patients in recovery from OUD are experiencing worse outcomes during the COVID-19 pandemic. If this mobile app demonstrates efficacy among a large national sample of patients, it has the potential to augment existing treatment programs, improve recovery capital, and reduce disproportionate impacts of COVID-19 on this vulnerable population.