Better Together: Integrating MOUD in African American Community Settings

摘要 阿片类药物治疗中参与和保留的种族差异 疾病（MOUD）是深刻和持久的，并具有破坏性的后果。黑人/非裔 美国人经历了全国阿片类药物过量死亡的最快增长， 2013年，现在过量死亡率高于白人。2020年，黑 死于阿片类药物过量的人数比前一年增加了45%，几乎翻了一番。 白色吸毒过量死亡人数的增加。尽管对MOUD的需求很大，但黑人/非裔美国人 比白人更不可能接受MOUD，特别是丁丙诺啡，并且 MOUD治疗保留率。我们自己和其他人的研究表明，耻辱，医疗不信任， 对法律的后果的恐惧以及对MOUD的偏见和误解导致了利用不足 MOUD在黑人/非洲裔美国人中的比例。为了解决这些障碍，外联，参与， 社区同伴恢复专家（受过培训的个人， SUD恢复的生活经验），在更广泛的环境中和通过远程医疗提供MOUD， 以及一种协作护理模式，其通常整合提供物质使用障碍治疗，或者 MOUD与丁丙诺啡在信任，社区网站，已被发现是可行的和有吸引力的 未治疗OUD的黑人/非裔美国人。我们提出了一个多站点混合实现- 在华盛顿、芝加哥和迈阿密/戴德县进行有效性试验，以评价： 1)实施综合协作社区MOUD护理模式（ICC-MOUD）， 2)该模型在使用丁丙诺啡的MOUD中改善6个月保留的有效性， 目前未经治疗的OUD黑人/非洲裔美国人与基于诊所的诊所相比 丁丙诺啡（MC-MOUD）。在ICC-MOUD中，社区网站充当“辐条”， 由丁丙诺啡提供者在“中心”丁丙诺啡诊所提供MOUD远程医疗， 同行恢复专家将在 社区，并作为社区站点远程医疗访问的促进者， 经过培训充当康复指导的卫生工作者将提供现场心理教育和行为指导， 咨询，以促进保留在护理，药物依从性，和行为改变。在MC-MOUD中， 参与者被转诊到MOUD诊所/办公室接受治疗。

Abstract 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. 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. Despite the great need for MOUD, Black/African Americans are less likely than whites to receive MOUD, especially buprenorphine, and have substantially lower rates of MOUD treatment retention. 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. To address these barriers, outreach, engagement, and reengagement by community-based Peer Recovery Specialists ( 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 in trusted, community sites, have been found to be feasible and attractive to Black/African American persons with untreated OUD. We propose a multi-site hybrid implementation- effectiveness trial to be conducted in Washington, DC, Chicago, and Miami/Dade County to evaluate: 1) implementation of the Integrated Collaborative Community MOUD care model (ICC-MOUD) and 2) the effectiveness of this model for improving 6-month retention in MOUD with buprenorphine among currently untreated Black/African Americans with OUD compared to Medical Clinic-office-based MOUD with buprenorphine (MC-MOUD). In ICC-MOUD, community sites serve as “spokes” for telemedicine provision of MOUD by buprenorphine providers based in a “hub” buprenorphine clinic, Peer Recovery Specialists will conduct outreach, engagement, and reengagement activities in the community and serve as facilitators for telemedicine visits at the community site, and a community health worker trained to serve as a Recovery Guide will provide on-site psychoeducation and behavioral counseling to promote retention in care, medication adherence, and behavioral change. In MC-MOUD, participants are referred to and treated entirely in a MOUD clinic/office.