Better Together: Integrating MOUD in African American Community Settings

更好地在一起：将 MOUD 融入非裔美国人社区环境

• 批准号: 10781200
• 负责人: Niranjan Subhash Karnik
• 金额: $ 29.72万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-10 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10781200
• 关键词: Acceleration; Accident and Emergency department; Address; African American; African American population; Behavioral; Black Populations; Black race; Buprenorphine; COVID-19; Caring; Chicago; Church; Cities; Clinic; Clinical Trials Network; Communities; Community Health Aides; Consolidated Framework for Implementation Research; Counseling; County; Drug abuse; Effectiveness; Faith; Federally Qualified Health Center; Fright; Human Resources; Illinois; Individual; Legal; Measures; Medicaid eligibility; Medical; Modeling; National Institute of Drug Abuse; Participant; Patients; Pharmaceutical Preparations; Protocols documentation; Provider; Randomized; Recovery; Research; Research Personnel; Services; Site; Socioeconomic Factors; Specialist; Substance Use Disorder; System; Telemedicine; Training; Trust; Universities; Visit; Washington; Work; collaborative care; community engagement; community organizations; community setting; comparative effectiveness; effectiveness evaluation; effectiveness/implementation trial; experience; implementation barriers; implementation facilitators; improved; medication compliance; opioid mortality; opioid overdose; opioid use disorder; outreach; overdose death; patient retention; peer recovery; prior authorization; psychoeducation; psychoeducational; racial disparity; social stigma

Racial disparities in engagement and retention in treatment with medication treatment for opioid use disorder (MOUD) are profound and persistent and have devastating consequences. Black/African American persons have experienced the fastest increases in opioid overdose deaths nationally since 2013 and now have higher rates of overdose deaths than whites [1,2]. COVID-19 has accelerated overdose deaths especially among Black/African Americans: during 2020, the number of Black persons dying from an opioid overdose increased by 45% compared to the previous year, nearly double the increase for white overdose deaths [3]. Despite the great need for MOUD, Black/African Americans are substantially less likely than whites to receive MOUD, especially buprenorphine, and have substantially lower rates of MOUD treatment retention [4-8]. These differences in MOUD treatment engagement and retention persist even when controlling for socioeconomic factors and despite reducing barriers to MOUD (e.g., expanding Medicaid eligibility, eliminating co-pays or prior authorization requirements) and increasing its availability in a broad range of medical settings (e.g., medical offices, clinics, federally qualified health centers, and Emergency Departments) [8-13]. Our own and others’ research identify that stigma, medical mistrust, fear of legal consequences, and bias and misunderstanding about MOUD contribute to underutilization of MOUD in Black/African American populations [14-17]. To address these barriers, outreach, engagement, and reengagement by community-based Peer Recovery Specialists (PRS, trained individuals with shared lived experience of SUD recovery), providing MOUD in a broader range of settings and by telemedicine, and a collaborative care model integrating provision of substance use disorder treatment generally or MOUD with buprenorphine (supported by telemedicine) in trusted, community sites, including churches or faith-based or secular community organizations, have been found to be feasible and attractive to Black/African American persons with untreated OUD [18-26]. Additional research is needed, however, to evaluate barriers and facilitators for implementation of a collaborative care model integrating provision of MOUD with buprenorphine and provision of PRS services in community-based sites and to evaluate the effectiveness of this MOUD care model compared to MOUD with buprenorphine provided in medical offices or clinics for urban Black/African Americans with OUD.

阿片类药物使用障碍药物治疗中参与和保留的种族差异 (穆德)是深刻和持久的，并具有毁灭性的后果。黑人/非裔美国人 自2013年以来，阿片类药物过量死亡人数在全国范围内增长最快，现在 服药过量死亡率高于白人[1，2]。新冠肺炎加速了过量死亡，特别是在 黑人/非裔美国人：2020年间，死于阿片类药物过量的黑人人数有所增加 与前一年相比增加了45%，几乎是白人过量死亡增加的两倍[3]。尽管 非常需要穆德，黑人和非裔美国人接受穆德的可能性比白人小得多， 尤其是丁丙诺啡，而且Moud治疗的保留率大大降低[4-8]。这些 即使在控制了社会经济因素的情况下，Moud治疗参与度和保留率的差异仍然存在 因素和尽管降低了MOD的障碍(例如，扩大医疗补助资格、取消自付或优先 授权要求)，并在广泛的医疗环境中增加其可用性(例如，医疗 办公室、诊所、经联邦认证的卫生中心和急诊科)[8-13]。我们自己的和其他人的 研究发现，耻辱、医学上的不信任、对法律后果的恐惧以及偏见和误解 关于穆德导致黑人/非裔美国人对穆德的利用不足[14-17]。致信地址 社区同伴恢复专家的这些障碍、外展、参与和重新参与 (受过培训、具有共同的SUD恢复生活经验的个人)，在更广泛的范围内提供Moud 通过环境和远程医疗，以及整合提供物质使用障碍的协作护理模式 在受信任的社区站点使用丁丙诺啡(由远程医疗支持)进行一般或Moud治疗， 包括教会或基于信仰或世俗的社区组织，已被发现是可行的 对未经治疗的黑人/非裔美国人有吸引力[18-26]。还需要更多的研究， 然而，要评估实施协作护理模式的障碍和促进者， 向Moud提供丁丙诺啡，并在基于社区的地点和 评估此Moud护理模式与Moud使用丁丙诺啡的效果 为患有OUD的城市黑人/非裔美国人提供的医务室或诊所。