Developing and testing an intervention to enhance recovery capital amid opioid use disorder pharmacotherapy: A pilot randomized trial of assertive linkage to recovery community centers

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(K.220) 7. Project Summary/Abstract Opioid use disorder (OUD) is associated with disproportionate deficits in the psychosocial determinants of health, with individuals exhibiting recovery capital (i.e. recovery resources) that is one standard deviation below that of other substance use disorders (SUDs) in the first year of recovery. OUD medications (MOUDs) are first-line treatments (Txs) that facilitate recovery by addressing the biophysiological disturbances caused by chronic opioid misuse. Yet, high rates of MOUD discontinuation and associated risks are ongoing concerns and, even when patients (Ps) are retained in Tx, psychosocial deficits often persist, increasing biobehavioral stress and hindering Tx/recovery. Thus, without a foundation of resources for recovery support/maintenance, current and former MOUD Ps are at ongoing risk for psychosocial impairment, which hinders recovery. The provision of recovery support services (RSS) offers one way to address extra-Tx needs and enhance recovery capital to ensure a safety net of resources and healthy coping skills to support MOUD Ps during and after Tx. Recovery Community Centers (RCCs) are a free, newly emerging, and rapidly growing tier of RSS that serve as ‘one-stop- shops’ for recovery capital, offering an array of services catered to the SUD community. RCCs seem to be especially well suited for MOUD Ps, as they operate under the maxim “many pathways [to recovery], all should be celebrated” (including MOUD), and the majority of RCC attendees have OUD and hold positive attitudes toward MOUD. Though early evidence suggests that RCCs can aid SUD recovery, its potential benefit to MOUD Ps has yet to be directly studied. Also, few MOUD Ps know of or use RCCs, and clinical linkage to them is uncommon. Thus, this 5-year project seek to advance our understanding of the clinical and public health utility of RCCs and help bridge the gap between clinical Tx and community-based RSS. As a first step in this work, we will develop and test a new intervention for peer-facilitated assertive linkage of MOUD Ps to RCCs (RCCL), relative to a matched control condition (CC). This study aims to: (1) develop, manualize, and refine RCCL/CC protocols via stakeholder feedback; (2) determine feasibility, acceptability, and preliminary efficacy (RCC attendance, service use, recovery capital) of RCCL vs. CC, via a pilot randomized controlled trial (RCT); (3) Gain in-depth insight to RCCL via qualitative interviews. This study will be the first to test RCCL for MOUD Ps, providing a foundation for larger-scale RCTs, with the potential to ultimately change clinical practice paradigms to address Ps’ extra-Tx needs and inform our ability to expand RCCL provision nationally. The aims support advanced training in: psychosocial determinants of health; RSS; intervention development/testing (via RCT); qualitative methods; ongoing OUD training, with a new focus on intervention research. Training will be fulfilled with expert guidance from Drs. John Kelly, Roger Weiss, Joanne Neale, David Best, Christine Timko, and Corrie Vilsaint. The training and experience provided by this award will serve as a critical foundation from which to build a an important and clinically relevant program of independent research.