Peer-Delivered, Behavioral Activation Intervention to Improve Polysubstance Use and Retention in Mobile Telemedicine OUD Treatment in an Underserved, Rural Area

同伴提供的行为激活干预可改善服务不足的农村地区移动远程医疗 OUD 治疗中多物质的使用和保留

• 批准号: 10578063
• 负责人: Sarah M. Kattakuzhy
• 金额: $ 235.79万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10578063
• 关键词: Abstinence; Address; Adherence; Adoption; Appointment; Area; Behavior Therapy; Behavioral; Buprenorphine; Caring; Communities; Effectiveness; Environment; Evidence based intervention; Health; Health Care Sector; Health Personnel; Individual; Intake; Intervention; Lead; Left; Maryland; Medical; Medically Underserved Area; Methods; Modeling; Nurses; Outcome; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Population; Positive Reinforcements; Proctor framework; Professional counselor; Provider; Psychological reinforcement; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Recovery; Recovery Support; Resources; Rewards; Rural; Rural Community; Rural Population; Services; Site; Specialist; Substance Use Disorder; Telemedicine; Training; Urinalysis; Work; acceptability and feasibility; addiction; base; community setting; contingency management; cost; cost effectiveness; design; economic value; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; effectiveness outcome; experience; free behavior; implementation cost; implementation evaluation; implementation outcomes; improved; non-opioid analgesic; opioid overdose; opioid use; opioid use disorder; peer; peer support; polysubstance use; primary outcome; provider-level barriers; rural America; rural area; rural counties; rural underserved; stimulant use; stimulant use disorder; substance use; treatment as usual; treatment services; underserved area; underserved rural area; urban area; virtual; waiver

Background. More than 50% of rural counties in the US do not have a single buprenorphine-waived provider, and approximately 10% of people in the US live more than 10 miles away from their nearest prescriber. Compounding the devastating effects of the opioid use disorder (OUD) crisis in underserved, rural areas is increasing polysubstance use, notably stimulant use disorder co-occurring with OUD. Since 2019, our team has filled a void of rural addiction treatment practitioners in underserved rural Maryland areas by providing buprenorphine for OUD treatment with the use of telemedicine (TM) aboard a mobile treatment unit (MTU). Our team has demonstrated the effectiveness of the TM-MTU model in reducing opioid use by 32.8% at three- months. Yet, 92% of patients in the past year presented with polysubstance use at intake, approximately half with OUD and stimulant use. Further, treatment retention is a challenge, amplified by polysubstance use; less than 60% of patients were retained at three-months. Reinforcement-based approaches, such as contingency management, have empirical support for improving treatment retention and stimulant use, yet have low adoption in community settings due to organizational and provider barriers, including cost. A behavioral reinforcement-based approach, such as behavioral activation (BA), which aims to increase positive reinforcement through rewarding, substance-free behaviors, may be a promising effective and sustainable strategy to improve both OUD treatment retention and polysubstance use, particularly stimulant use. Further, our team has demonstrated that it is feasible to train peer recovery specialists (PRSs) in BA. Preliminary Studies. This proposal builds upon our team’s prior studies demonstrating the feasibility, acceptability, and effectiveness of: 1) the TM-MTU model reaching rural communities hard hit by the OUD crisis and polysubstance use; 2) integrating PRS support on the TM-MTU; and 3) a PRS-delivered BA intervention (“Peer Activate”) for improving treatment retention and reducing polysubstance use, including OUD and stimulant use. Approach. Building upon this work, we propose a randomized Type 1 hybrid effectiveness-implementation trial (n=180) to evaluate the PRS-delivered BA intervention on the MTU (Peer Activate-MTU) compared to enhanced treatment as usual (ETAU; facilitated referrals and general peer support) on the following over 12- months: (1) effectiveness outcomes: a) OUD treatment retention (primary: chart review of appointment attendance); b) polysubstance use (co-primary: urinalysis of co-occurring use of ≥2 substances); and c) buprenorphine adherence (secondary: urinalysis and pharmacy refill); (2) implementation outcomes, including feasibility, acceptability, fidelity, and adoption guided by RE-AIM; (3) cost of implementing and sustaining Peer Activate-MTU and its economic value relative to ETAU. Implications. This proposal is designed to lead to a potentially scalable model for improving OUD treatment retention and polysubstance use, particularly co- occurring OUD and stimulant use, and increasing the reach of addiction treatment in underserved, rural areas.

背景。美国超过50%的农村县没有一家丁丙诺啡豁免供应商，