Better Together: Integrating MOUD in African American Community Settings

摘要

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.