Better Together: Integrating MOUD in African American Community Settings

摘要 阿片类药物治疗中参与和保留方面的种族差异 混乱(穆德)是深刻和持久的，并具有毁灭性的后果。黑人/非洲人 自那以来，美国人经历了全国阿片类药物过量死亡人数增长最快的情况 2013年，现在服药过量死亡率高于白人。2020年间，黑人的数量 与前一年相比，死于阿片类药物过量的人数增加了45%，几乎翻了一番。 白人服药过量死亡人数的增加。尽管对穆德的需求很大，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，而且大大低于白人 Moud治疗保留率。我们自己和其他人研究发现，耻辱、医学上的不信任 对法律后果的恐惧，以及对穆德的偏见和误解导致利用不足 在黑人/非裔美国人群体中的Moud。为了解决这些障碍，外展、参与、 以及基于社区的同伴恢复专家的重新参与(受过培训的个人通过共享 SUD恢复的现场体验)，在更广泛的环境中通过远程医疗提供Moud， 以及协作护理模式，其整合了一般或 在受信任的社区站点使用丁丙诺啡的Moud已被发现是可行的和有吸引力的 未经治疗的黑人/非裔美国人。我们提出了多站点混合实施方案- 有效性试验将在华盛顿特区、芝加哥和迈阿密/戴德县进行，以评估： 1)实施综合协作社区Moud护理模式(ICC-Moud)和 2)该模型对丁丙诺啡改善小鼠6个月保留率的有效性 与医疗诊所相比，目前未接受治疗的黑人/非洲裔美国人患有OUD-基于办公室 丁丙诺啡Moud(MC-Moud)。在ICC-Moud，社区网站充当 在“中心”丁丙诺啡诊所的丁丙诺啡提供者远程医疗提供Moud， 同伴恢复专家将在以下地点开展外展、参与和重新参与活动 社区，并在社区站点和社区担任远程医疗访问的促进者 接受康复指导培训的卫生工作者将提供现场心理教育和行为 提供咨询，以促进护理中的保留、服药依从性和行为改变。在MC-Moud， 参与者完全在穆德诊所/办公室接受转介和治疗。

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.