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：美国正在经历一场前所未有的阿片类药物流行。 治疗阿片使用障碍(MOUD)的药物，如美沙酮、丁丙诺啡和缓释剂 纳曲酮是推荐的治疗标准。然而，穆德有许多治疗障碍 坚持和保留导致HIGH Moud停用。穆德辍学人数上升预示着糟糕的前景 健康后果包括增加阿片类药物的使用/复发、过量服药和死亡。为了进一步复合 在目前的阿片类药物危机中，没有既定的循证干预措施专门侧重于改善 Moud的依从性和保留性，以及治疗提供者使用的典型策略受到临床- 基于。因此，这项研究的目标是通过开发一种利用 在常规治疗之外，两种广泛使用的现有恢复支持服务的影响：同伴恢复支持 服务(PRSS)和恢复住宅(RR)。PRSS干预将包括以下组成部分： 教练、指导、教育和其他支持由同龄人提供，这些同龄人在他们的生活中独树一帜 有药物使用障碍的经历。RR是干预的另一个关键组成部分，因为它们 为康复者提供支持性的生活环境。干预措施将根据具体情况量身定做 促进穆德的坚守。同行将嵌入本地提供商社区，提供自信 在护理期间进行外展，强调继续治疗，并强调在治疗后返回护理 治疗中途退出和/或复发。将PRSS和RRS结合起来以改进的潜在协同效益 Moud保留率相当高，其影响将通过将这两个组件都包括在 在这项拟议的研究性研究中制定的干预措施。这项研究涉及三个相互关联的方法学阶段 我们的具体目标是在36个月内连续出现的。第一阶段包括干预的准备工作 实施包括建立一个区域资源中心网络，该网络将成为区域工作队试点的招聘地点，招聘和 培训同伴支持专家，开展焦点小组和访谈，以收集利益相关者的意见，以及 开发PRSS方法以促进Moud保留。我们将在(n=5)中测试PRSS干预 从合作RRS招募的人员，为第二阶段做准备。第二阶段包括进行试验性RCT 通过将Moud上居住在合作伙伴RRS中的个人(N=50)随机分配到以下任一组进行PRSS干预： 在常规治疗(TAU)的基础上加用PRSS干预的24周疗程，或不加PRSS的TAU 干预。我们随机对照试验的主要结果是24周内累积的Moud滞留。最后，阶段 3包括收集关于PRSS干预的额外质量投入，并进行数据分析以提供信息 R01后续应用的方法学。这一研究轨迹将通过直接支持NIH的任务 解决Moud依从率和保留率较低的问题，这些问题正在加剧 阿片类药物危机。