NorthStar Node of the Clinical Trials Network

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Project Summary Since the COVID-19 pandemic, American Indian and Alaska Native (AIAN) adults now experience the highest rate of drug overdose in the United States, which is 31% higher than that of White adults.1 AI/AN adults are particularly at high risk for opioid use disorder (OUD) due to elevated risk of chronic health conditions influenced primarily by social determinants of health, as well as historical trauma.2 Illicit use of opioids is a major public health problem associated with significant morbidity and mortality related to HIV, hepatitis C, and overdose.3-5 AIAN adults in Minnesota are seven times more likely to die of an overdose involving opioids than whites, representing the greatest disparity observed between AIAN and whites in the US.6 Medication for opioid use disorder (MOUD) is an evidence-based approach,7-9 and strategies to promote the continuation of pharmacotherapy and support OUD recovery are important.10,11 Gender-specific factors affecting opioid use relapse and recovery that are more prevalent in women compared with men include perceived stress, trauma, and enhanced biological stress reactivity; as well as less social support for abstinence.12,13 AIAN gender- specific interventions for OUD do not exist. Research has documented the positive impact of social networks and social support on abstinence from substance use.145 However, understanding how best to leverage social support remains a key challenge for the addictions treatment field.15 In NIDA CTN-0123 (Aim 1) we are addressing these gaps by developing a social digital (Facebook) intervention to promote stress management and social network support for opioid abstinence among AIAN women. Especially with the COVID-19 pandemic, virtual digital platforms have potential for greater reach and scale.16,17 Consistent with the AIAN cultural value of interdependence, social media-formed groups to prevent opioid relapse could lead to greater adoption and sustainability by encouraging collaborative efforts across generations of AIAN women and leveraging community resilience for coping with stress.18-21 The overall research objective is to develop and evaluate the feasibility of a Facebook intervention for supporting recovery from opioid use among AIAN women. This project was designed with community partners at the MN Indian Women’s Resource Center (MIWRC). A community advisory committee (CAC) contributed to the development of the Facebook intervention content and study protocol for Aim 1 (NIDA CTN 0123) and will continue to guide all study activities for the Aim 2 pilot RCT proposed here.