Peer Recovery Support Services for individuals in Recovery Residences on MOUD

MOUD 为康复住宅中的个人提供同伴康复支持服务

• 批准号: 10589601
• 负责人: MARC FISHMAN
• 金额: $ 76.9万
• 依托单位: MARYLAND TREATMENT CENTERS, INC.
• 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/10589601
• 关键词: Accountability; Address; Adherence; Aftercare; Assertiveness; Attitude; Behavior; Buprenorphine; Caring; Cessation of life; Clinic; Clinical; Communities; Continuity of Patient Care; Data; Data Analyses; Data Collection; Dropout; Education; Environment; Evidence based intervention; Face; Focus Groups; Future; Goals; Group Interviews; Health; Health Personnel; Housing; Individual; Intervention; Knowledge; Link; Mentors; Methadone; Methodology; Mission; Monitor; Motivation; Naltrexone; Opioid; Outcome; Overdose; PRSS8 gene; Participant; Patient Recruitments; Persons; Pharmaceutical Preparations; Pharmacotherapy; Phase; Preparation; Procedures; Provider; Public Health; Randomized; Recovery; Recovery Support; Relapse; Research; Role; Services; Site; Specialist; Structure; Substance Use Disorder; Testing; Training; Treatment Efficacy; United States; United States National Institutes of Health; Waxes; addiction; adherence rate; barrier to care; base; care episode; common treatment; design; efficacious intervention; efficacy testing; experience; follow-up; implementation intervention; improved; opioid epidemic; opioid use; opioid use disorder; outreach; overdose death; peer; peer support; pilot test; post intervention; primary outcome; recruit; research study; residence; retention rate; secondary outcome; service intervention; social stigma; standard care; standard of care; treatment as usual; trial design

Project Summary/Abstract: The United States is experiencing an unprecedented opioid epidemic. Medications for opioid use disorder (MOUD), such as methadone, buprenorphine, and extended-release naltrexone, are the recommended standard of care. There are, however, many treatment barriers to MOUD adherence and retention that result in high MOUD discontinuation. This elevated MOUD dropout predicts poor health outcomes including increased opioid use/relapse, overdose, and death. To further compound the current opioid crisis, there are no established evidence-based interventions that specifically focus on improving MOUD adherence and retention, and typical strategies used by treatment providers are limited by being clinic- based. Thus, the goal of this study is to address this gap by developing an intervention that leverages the impact of two widely used existing recovery support services outside of usual treatment: peer recovery support services (PRSS) and recovery residences (RRs). The PRSS intervention will include the following components: coaching, mentoring, education, and other supports delivered by peers uniquely qualified by their lived experience with substance use disorder. RRs are another critical component of the intervention because they provide a supportive living environment for persons in recovery. The intervention will be tailored to specifically promote MOUD adherence. Peers will be embedded within the local provider community, provide assertive outreach between episodes of care, emphasize continuation in treatment, and emphasize return to care after treatment dropout and/or relapse. The potential synergistic benefits of combining PRSS and RRs to improve MOUD retention are considerable, and their impact will be investigated by including both components in the intervention developed in this proposed research study. The study involves three methodological phases linked to our specific aims that occur sequentially over 36 months. Phase 1 consists of preparation for the intervention implementation including building a network of RRs that will be recruitment sites in the pilot RCT, recruiting and training peer support specialists, conducting focus groups and interviews to gather stakeholder input, and developing PRSS approaches to promote MOUD retention. We will test the PRSS intervention in (n=5) individuals recruited from partnering RRs to prepare for Phase 2. Phase 2 consists of conducting the pilot RCT of the PRSS intervention by randomizing individuals (N=50) on MOUD who reside in partner RRs to either: a 24-week course of the PRSS intervention added to treatment as usual (TAU), or TAU without the PRSS intervention. Our primary outcome of the RCT is cumulative MOUD retention over the 24-weeks. Finally, phase 3 involves gathering additional qualitative input on PRSS intervention and conducting data analyses to inform the methodology for a follow-up R01 application. This research trajectory will support NIH’s mission by directly addressing the low MOUD adherence and retention rates that are exacerbating the devastating effects of the opioid crisis.

项目摘要/摘要：美国正在经历前所未有的阿片类药物流行。 治疗阿片类药物使用障碍 (MOUD) 的药物，例如美沙酮、丁丙诺啡和缓释药物 纳曲酮是推荐的护理标准。然而，MOUD 存在许多治疗障碍 坚持和保留会导致 MOUD 终止率较高。 MOUD 脱落率升高预示着较差的 健康结果包括阿片类药物使用增加/复发、用药过量和死亡。为了进一步复合 当前的阿片类药物危机，没有既定的循证干预措施专门致力于改善 MOUD 的坚持和保留以及治疗提供者使用的典型策略受到临床的限制。 基于。因此，本研究的目标是通过开发一种干预措施来解决这一差距 常规治疗之外两种广泛使用的现有康复支持服务的影响：同伴康复支持 服务 (PRSS) 和康复住宅 (RR)。 PRSS 干预措施将包括以下组成部分： 由具有独特资格的同龄人提供的指导、指导、教育和其他支持 物质使用障碍的经验。 RR 是干预措施的另一个重要组成部分，因为它们 为康复者提供支持性的生活环境。干预措施将专门针对 促进 MOUD 的遵守。同行将嵌入本地提供商社区，提供自信的 在两次护理之间进行外展，强调继续治疗，并强调治疗后返回护理 治疗中途退出和/或复发。结合 PRSS 和 RR 来改善的潜在协同效益 MOUD 保留量相当大，将通过将这两个组件包含在 在这项拟议的研究中开发的干预措施。该研究涉及三个相互关联的方法学阶段 实现我们在 36 个月内连续实现的具体目标。第一阶段包括干预准备 实施包括建立一个 RR 网络，作为试点 RCT 的招募地点、招募和 培训同行支持专家，进行焦点小组和访谈以收集利益相关者的意见，以及 制定 PRSS 方法以促进 MOUD 保留。我们将在 (n=5) 中测试 PRSS 干预 从合作 RR 中招募人员为第 2 阶段做准备。第 2 阶段包括进行试点 RCT 通过将居住在合作伙伴 RR 中的 MOUD 个体（N = 50）随机分配到以下任一者来实施 PRSS 干预： 24 周的 PRSS 干预疗程添加到常规治疗 (TAU) 中，或不使用 PRSS 的 TAU 干涉。我们 RCT 的主要结果是 24 周内累积的 MOUD 保留率。最后，相 3 涉及收集有关 PRSS 干预的额外定性输入并进行数据分析以提供信息 后续 R01 申请的方法。这一研究轨迹将通过直接支持 NIH 的使命 解决 MOUD 依从性和保留率低的问题，这些问题加剧了 MOUD 的破坏性影响 阿片类药物危机。