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

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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.