Adapting the HOPE Online Support Intervention to Increase MAT Uptake Among OUD Patients

在一项随机对照试验中，该应用程序寻求评估使用在线同伴支持社区干预在在线招募的阿片类药物使用障碍(OUD)参与者中增加Moud启动和维持的有效性。 在美国，平均每天有130人死于阿片类药物过量，使阿片类药物危机成为美国最大的公共卫生问题(1，2)。尽管FDA批准的治疗阿片使用障碍(MOUD)的有效药物可用于阿片使用障碍(OUD)患者，包括丁丙诺啡和注射用纳曲酮，但只有一小部分受益于这些药物的人使用它们。Moud使用率低的原因有很多，包括缺乏保险；提供者和患者之间的知识；与Moud相关的污名；以及社会规范(例如，如果同龄人也使用Moud，人们会更愿意使用Moud)。需要创新的方法，特别是那些涉及多个层面(例如，个人、文化和社会/社区)的方法，以增加患有OUD的个人对Moud的使用。 在线同行主导的支持干预可能在增加Moud接受方面特别有效，因为它们可以利用同行在整个人们的自然、现实世界和虚拟环境中广泛和快速地扩大社会规范(例如，对使用Moud的兴趣)的变化。例如，利用在线同伴教育(HOPE)干预，这是一种旨在减少耻辱和增加健康行为改变的在线同伴支持社区干预措施，已被证明在改变受耻辱的人群中的健康行为方面有效，例如艾滋病毒。针对与阿片类药物相关的问题，我们的团队最近发现，希望干预是一种可行且可接受的方法，可以降低接受阿片类药物治疗的慢性疼痛患者滥用处方阿片类药物的风险。然而，还没有研究在线支持干预，如HOPE，是否在增加OUD患者的Moud请求、吸收和支持方面可能有效。因此，评估这些社会规范/行为技术方法对于降低阿片类药物过量增加的比率至关重要。 在这项研究中，我们试图探索是否以及如何采用希望在线支持干预措施来增加有Moud的参与者的Moud发起和维持，评估使用干预措施在没有使用Moud的在线招募的OUD参与者中增加Moud请求的有效性，并使用实施科学方法确定在线社区数据和行为变化之间的关系。

In a randomized controlled trial, with 3, 6-month and 1-year follow-up, this application seeks to assess the effectiveness of using an online peer support community intervention to increase MOUD initiation and sustainment among participants with opioid use disorder (OUD) who are recruited online. On average, 130 people die in the United States each day from opioid overdoses, making the opioid crisis the country’s top public health concern (1,2). Although effective FDA-approved medication for opioid use disorder (MOUD) is available for patients with opioid use disorder (OUD), including buprenorphine and injectable naltrexone, only a small fraction of those who would benefit from these medications use them. There are a number of reasons for low MOUD use, including lack of insurance; knowledge, among both providers and patients; MOUD-related stigma; and social norms (e.g., people would be more willing to use MOUD if their peers were also using MOUD). Innovative methods, especially those that address multiple levels (e.g., the individual, culture, and society/community) are needed to increase MOUD use among individuals with OUD. Online peer-led support interventions might be particularly effective at increasing MOUD uptake because they can leverage peers to widely and rapidly scale changes in social norms (e.g., interest in using MOUD) throughout people’s natural, real-world, virtual environments. For example, the Harnessing Online Peer Education (HOPE) intervention, an online peer support community intervention designed to reduce stigma and increase health behavior change, has been shown to be effective at changing health behaviors among stigmatized populations, such as for HIV. Specific to opioid-related issues, our team recently found the HOPE intervention to be a feasible and acceptable method of reducing risk for prescription opioid misuse among chronic pain patients on opioid therapy. However, no research has studied whether online support interventions, such as HOPE, might be effective in increasing MOUD requests, uptake, and sustainment among OUD patients. It is therefore critical to evaluate these social normative/behavioral technology methods to reduce the increasing rate of opioid overdose. In this study, we seek to explore whether and how the HOPE online support intervention might be adapted to increase MOUD initiation and sustainment among participants with OUD, assess the effectiveness of using the intervention to increase MOUD requests among OUD participants recruited online who are not using MOUD, and using an implementation science approach determine the relationship between online community data and behavior change.