Counseling for Harm Reduction and Retention in Medication-assisted treatment - Cherokee Nation (CHaRRM-CN)

药物辅助治疗中减少伤害和保留的咨询 - Cherokee Nation (CHaRRM-CN)

• 批准号: 10810247
• 负责人: Susan E Collins
• 金额: $ 3.62万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10810247
• 关键词: Affect; Alaska Native; American Indians; Caring; Centers for Disease Control and Prevention (U.S.); Cherokee Indian; Clinical Psychology; Communities; Counseling; Data; Development; Disparity; Effectiveness; Event; Evidence based intervention; Foundations; Funding; Future; Goals; Harm Reduction; Individual; Intervention; Length; Literature; Measures; Medical; Methods; Monitor; National Institute of Drug Abuse; Native-Born; Opioid; Outcome; Overdose; Overdose reduction; Participant; Patients; Perception; Persons; Pharmaceutical Preparations; Phase; Positioning Attribute; Recommendation; Research; Research Personnel; Research Project Grants; Running; Service provision; Suboxone; Testing; Text; Time; Treatment Efficacy; Treatment outcome; Tribes; United States; United States National Institutes of Health; Work; arm; career; community based participatory research; effectiveness evaluation; efficacy testing; experience; follow-up; graduate student; healing; health disparity; health related quality of life; illicit opioid; improved; insight; medication-assisted treatment; mortality; multi-component intervention; opioid epidemic; opioid mortality; opioid use; opioid use disorder; outreach; overdose death; patient engagement; programs; retention rate; secondary outcome; substance use; substance use treatment; systematic review; telehealth; therapy development; treatment duration; treatment program; treatment services

ABSTRACT American Indian (AI) people are disproportionately impacted by opioid use disorder (OUD) and its related harm. From 2019 to 2020, there was a 39% increase in overdose mortality rates for American Indian/Alaska Native (AI/ANs) people compared to 22% for white people. As evinced by the current OUD milieu, opioid-related disparities are amplified among AI people. Fortunately, medication-assisted treatment (MAT) is highly efficacious in reducing overdose and opioid-related harm. Despite being the gold-standard of OUD treatment, MAT’s efficacy is contingent on treatment retention. A systematic review found a median retention rate of 56% at the 12-month treatment period. This is concerning due to treatment retention being associated with reduced mortality rates within OUD. In addition, there are no studies to date that have analyzed the effectiveness of MAT in AI communities. Despite the dearth of literature, research has indicated that gathering insight from those who are affected by OUD is critical to improving substance-use treatment. Correspondingly, a new NIH-funded CBPR research project entitled, “Counseling for Harm Reduction and Retention in MAT in Cherokee Nation” (CHaRRM- CN; R61/R33DA049376; PIs: Nelson, Collins, Taylor), is engaging the largest tribally run MAT program in the US to collaboratively improve MAT for AI people with OUD. In the prior R61 phase, results were presented to a community advisory board and used to codevelop a lower-barrier, more culturally aligned and community-driven approach to MAT. The resulting CHaRRM-CN components include: harm-reduction and culturally aligned counseling, lower-barrier MAT service provision, monitoring of participant charts, and increasing connection to community-based cultural events. The current R33 phase of this project will assess the effectiveness of the resulting components in improving MAT retention, substance-related harm, and illicit opioid use. The subsequent diversity supplement will expand upon this work. Emma Shinagawa is a second-year clinical psychology graduate student whose career goal is to work collaboratively with people who use substances and other community stakeholders to develop and disseminate evidence-based interventions as an independent researcher. The supplement she proposes titled Perceptions and Relative Contributions of Components in the Context of the Counseling for Harm Reduction and Retention in MAT with Cherokee Nation (CHaRRM-CN) Treatment for American Indian Medication Assisted Treatment (MAT) Patients with Opioid Use Disorder (OUD) will track the R33 CHaRRM-CN arm participants’ (N=80) engagement with various intervention components and evaluate whether overall engagement to CHaRRM-CN components and/or specific CHaRRM-CN components is associated with positive treatment outcomes. The primary treatment outcome is MAT retention with secondary outcomes being cultural connectedness, substance-related harm and illicit opioid-use This supplement will facilitate Ms. Shinagawa’s development into an independent investigator and will build upon her prior experience working with communities impacted by substance use.

抽象的 美洲印第安人 (AI) 受到阿片类药物使用障碍 (OUD) 及其相关危害的影响尤为严重。 从 2019 年到 2020 年，美洲印第安人/阿拉斯加原住民的服药过量死亡率增加了 39% （AI/AN）人相比，白人的这一比例为 22%。正如当前 OUD 环境所表明的那样，阿片类药物相关 人工智能人之间的差距被放大。幸运的是，药物辅助治疗（MAT）非常有效 减少过量服用和阿片类药物相关的伤害。尽管 MAT 是 OUD 治疗的黄金标准，但其疗效 取决于治疗的保留。系统评价发现 12 个月的中位保留率为 56% 治疗期。这是令人担忧的，因为保留治疗与死亡率降低有关 在 OUD 内。此外，迄今为止还没有研究分析 MAT 在 AI 中的有效性 社区。尽管缺乏文献，但研究表明，从那些正在研究的人那里收集见解 受 OUD 影响对于改善药物滥用治疗至关重要。相应地，NIH 资助的新 CBPR 题为“切罗基族减少伤害和保留 MAT 的咨询”的研究项目（CHaRRM- 中文; R61/R33DA049376； PI：Nelson、Collins、Taylor）正在参与该地区最大的部落运行的 MAT 项目 美国将与 OUD 合作改善人工智能人员的 MAT。在之前的 R61 阶段，结果提交给 社区咨询委员会，用于共同开发一个门槛更低、文化更协调、社区驱动的组织 MAT 方法。由此产生的 CHaRRM-CN 组成部分包括：减少危害和文化协调 咨询、低门槛 MAT 服务提供、参与者图表监控以及增加与 以社区为基础的文化活动。该项目当前的 R33 阶段将评估 由此产生的成分可改善 MAT 保留、物质相关伤害和非法阿片类药物使用。随后的 多样性补充将扩展这项工作。艾玛品川是临床心理学二年级学生 研究生，其职业目标是与使用物质和其他物质的人合作 社区利益相关者作为独立机构制定和传播基于证据的干预措施 研究员。她提出的补充题为《感知和各组成部分的相对贡献》 与切罗基民族 (CHaRRM-CN) 的 MAT 中减少和保留危害咨询的背景 患有阿片类药物使用障碍 (OUD) 的美洲印第安人药物辅助治疗 (MAT) 患者的治疗 将跟踪 R33 CHaRRM-CN 组参与者 (N=80) 对各种干预组件的参与情况，以及 评估是否全面参与 CHaRRM-CN 组件和/或特定 CHaRRM-CN 组件 与积极的治疗结果相关。主要治疗结果是 MAT 保留，次要治疗结果是 MAT 保留 结果是文化联系、物质相关伤害和非法阿片类药物使用该补充将 促进品川女士发展成为一名独立调查员，并将以她之前的经验为基础 与受药物使用影响的社区合作。