New Mexico Clinical Trials Node: Clinical research and practice to address substance use in diverse, rural and underserved populations

早在2020年2月，美国印第安人和阿拉斯加原住民(AI/AN)社区就开始报告 与美国其他地区相比，新冠肺炎的患病率有所上升。与非卫生保健人员(21%)相比，34% 的AI/AN成年人患新冠肺炎相关严重疾病的风险最大。AI/AN成年人也更有可能 患有潜在的健康状况，进一步增加了感染新冠肺炎的易感性，例如 糖尿病、心血管疾病和癌症。这些升高的风险因历史和政治原因而加剧 因素，包括人口因天花和西班牙流感而崩溃，社会经济低迷 状况、获得所需护理的障碍以及印度卫生服务长期资金不足。至 AI/AN人群占新墨西哥州人口的11%，生动地说明了与新冠肺炎相关的差异，但 占该州新冠肺炎病例的55%以上，其中10例纳瓦霍民族报告确认3912例 病例和140例死亡(截至2010年5月21日)。为了满足药物使用障碍患者的治疗需求， 尤其是阿片类药物使用障碍(OUD)，在新冠肺炎紧急情况下，联邦法规指导成瘾 提供的服务已经修改，包括在人工智能/人工智能社区内。变化包括扩展 远程医疗和虚拟行为健康提供，调整OUD的用药剂量策略，以及 改变成瘾服务的报销和保密政策和做法。虽然这些政策 转变是为了促进可用性和访问，但对采用、实施和 这些变化在服务于AI/AN社区的计划中的有效性。迫切需要数据来告知 新冠肺炎突发事件后的政策决策-即是否应该进一步制定和实施政策 展开或回滚。为了确保未来关于成瘾服务的政策决定 包括AI/AN社区的经验和需求、关于传播、采用和 在AI/AN服务成瘾治疗项目中执行联邦成瘾政策至关重要 重要性。这项研究的目标是快速调查传播、采用、实施和 部落社区物质使用的持续和与新冠肺炎相关的政策变化。 具体目标是评估COVID的传播、采用和实施情况- 19部落、州和联邦各级的政策和法规，包括对 CTN0096-1a全国部落成瘾调查(n=300)，并审查执行情况和成果 通过定性访谈在部落、州和联邦各级改变新冠肺炎的政策和法规 在提供者和消费者之间进行(n=50)。

As early as February of 2020, American Indian and Alaska Native (AI/AN) communities began to report increased prevalence rates of COVID-19 relative to the rest of the US. Compared to non-NHWs (21%), 34% of AI/AN adults are at greatest risk of COVID-19 related serious illness. AI/AN adults are also more likely to suffer from underlying health conditions that further increases vulnerability to COVID-19 infection, such as diabetes, cardiovascular disease, and cancer. These elevated risks are exacerbated by historical and political factors, including population collapses from smallpox and the Spanish flu, low socioeconomic status, obstacles to accessing needed care and chronic underfunding of the Indian Health Service. To vividly illustrate COVID-19-related disparities, AI/AN people comprise ~11% of the New Mexico population, yet account for more than 55% of COVID-19 cases in the state,10 with the Navajo Nation reporting 3,912 confirmed cases and 140 deaths (as of 5/21/20). To address the treatment needs of people with substance use disorders, especially opioid use disorder (OUD), during the COVID-19 emergency, federal regulations guiding addiction services delivery have been modified, including within AI/AN communities. Changes include expansion of telemedicine and virtual behavioral health delivery, adjusting medication dosing strategies for OUD, and altering reimbursement and confidentiality policies and practices for addiction services. Although these policy shifts were to promote availability and access, little is known about the adoption, implementation, and effectiveness of these changes among programs serving AI/AN communities. Data is critically needed to inform policy decisions following the COVID-19 emergency – that is, should policies be further developed and expanded or, alternatively, rolled back. In order to ensure future policies decisions about addiction service include experiences and needs of AI/AN communities, rapid research on the dissemination, adoption, and implementation of federal addiction policies among AI/AN-serving addiction treatment programs is of vital importance. The goal of this study is to rapidly investigate the dissemination, adoption, implementation, and sustainment of substance use and COVID-19 related policy changes among Tribal communities. The specific aims are to assess the dissemination, adoption, and implementation of COVID- 19 policy and regulations at Tribal, State, and Federal levels by including quantitative questions to the CTN0096-1a National Tribal Addiction Survey (n=300) and examine the implementation and outcomes of COVID-19 policy and regulation changes at the Tribal, State, and Federal levels through qualitative interviews conducted among providers and consumers (n=50).