Peer Recovery Support Services for individuals in Recovery Residences on MOUD

摘要：美国正在经历前所未有的阿片类药物流行病。 阿片类药物使用障碍（MOUD），如美沙酮，丁丙诺啡和缓释 纳洛酮是推荐的护理标准。然而，MOUD有许多治疗障碍 坚持和保留，导致高MOUD中断。这种升高的MOUD辍学预测不良 健康结果，包括阿片类药物使用/复发增加，过量和死亡。为了进一步复合 目前的阿片类药物危机，没有建立基于证据的干预措施，专门侧重于改善 MOUD的依从性和保留率，以及治疗提供者使用的典型策略受到诊所的限制， 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， 在通常治疗之外广泛使用的两种现有康复支助服务的影响：同伴康复支助 服务（PRSS）和恢复住所（RR）。减贫战略支助系统的干预措施将包括以下组成部分： 教练，指导，教育和其他支持，由同行提供独特的资格，他们的生活 物质使用障碍的经历。RR是干预的另一个关键组成部分，因为它们 为康复人士提供支援的生活环境。干预措施将专门针对 促进MOUD的遵守。同行将嵌入当地供应商社区，提供自信 在护理阶段之间的外展，强调治疗的持续性，并强调在治疗结束后返回护理 治疗脱落和/或复发。结合PRSS和RR以改善 MOUD保留是相当大的，其影响将通过将这两个组件包括在 在这项拟议的研究中开发的干预措施。该研究涉及三个方法阶段， 在36个月内连续发生的特定目标。第1阶段包括干预准备 实施包括建立一个RR网络，将其作为试点RCT的招募网站，招募和 培训同行支持专家，开展焦点小组和访谈，以收集利益相关者的意见，以及 制定PRSS方法，以促进MOUD的保留。我们将测试PRSS干预（n=5） 从伙伴关系区域代表中招募个人，为第2阶段做准备。第2阶段包括进行试点RCT 通过将居住在伴侣RR中的MOUD个体（N=50）随机分配至以下任一组进行PRSS干预： 24-PRSS干预加常规治疗（TAU）或TAU（无PRSS）的一周疗程 干预我们RCT的主要结果是24周内累积MOUD保留。最后，阶段 3涉及收集关于减贫战略支助系统干预措施的更多定性投入，并进行数据分析， 后续R 01申请的方法。这一研究轨迹将直接支持NIH的使命， 解决MOUD遵守率和保留率低的问题，这些问题加剧了 鸦片危机

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.