Counseling for Harm Reduction and Retention in Medication-assisted treatment - Cherokee Nation (CHaRRM-CN)

摘要 美国印第安人（AI）受到当前阿片类药物流行病的不成比例的影响。AI经历了88%的 OUD的患病率（1.5%）高于美国普通人群（0.8%），AI仅次于非拉丁裔 白人在阿片类药物过量死亡的经验（分别为13.9和17.5每10万人）。幸运的是， 药物辅助治疗（MAT;例如，丁丙诺啡+纳洛酮）对于减少阿片样物质- 相关的伤害，包括过量，使其成为黄金标准的OUD治疗方法。最近系统 然而，回顾显示，在NIDA推荐的12个月治疗时间内，中位保留率为56%。 此外，大多数患有OUD的AI不参加传统的物质使用治疗（62%）。这令人担忧，因为 坚持治疗与死亡率降低密切相关。尽管没有研究表明 针对AI的OUD治疗结果，土著社区的研究普遍强调了关注 关于高度指导性的西方医学物质使用治疗方法的文化接受度 (e.g.,认知行为疗法，12步编程）。此外，以前的研究 有物质使用障碍的AI希望更多的本地员工代表， 将适应文化的方法纳入他们接受的服务。文化适应办法 治疗与减少使用和相关问题有关。然而，目前没有 基于证据的，适应文化的咨询方法，用于解决MAT保留和阿片类药物相关的问题 伤害因此，我们提出了一个两阶段的R61/R33开发和评估项目，以响应RFA-DA- 19-013 -“应对阿片类药物使用障碍（OUD）在部落社区的SAMHSA和 CDC资助”。该项目将利用最近的联邦OUD治疗倡议资金（SAMHSA TI-18-016， CDC-RFA-OT 18 - 18030101 supp）作为一个平台，在文化上适应物质使用咨询，重点是 改善MAT保留和减少切罗基国家卫生系统（CNHS）内阿片类药物相关的危害。 为期2年的R61阶段将包括2个部分。首先，我们将进行混合方法调查，为研究提供信息 现有的、有效的、减少伤害的咨询方法和社区特定的、文化适应 approach.第二，我们将在2010年对由此产生的减少和保留伤害咨询进行手册化和试点。 MAT在切罗基国家（CHaRRM-CN）与社区咨询委员会组成的CNHS供应商， 工作人员、患者以及来自切罗基民族、华盛顿州立大学和该大学的研究人员 在华盛顿。随后的3年R33期将需要在CNHS内进行一项2组RCT（N=160） 测试CHaRRM-CN在改善6个月MAT保留、减少物质相关伤害和 非法阿片类药物使用，以及与照常服务对照条件相比增加的本地文化适应（即， 认知行为治疗）。

ABSTRACT American Indians (AIs) are disproportionately impacted by the current opioid epidemic. AIs experience an 88% higher prevalence of OUDs (1.5%) than the US general population (0.8%), and AIs are second only to non-Latinx whites in their experience of opioid overdose deaths (13.9 and 17.5 per 100,000, respectively). Fortunately, medication-assisted treatment (MAT; e.g., buprenorphine + naloxone) is highly effective for reducing opioid- related harm, including overdose, making it the gold-standard OUD treatment approach. A recent systematic review, however, showed a median retention of 56% at the NIDA-recommended 12-month treatment length. Further, most AIs with OUD do not attend traditional substance-use treatment (62%). This is concerning because treatment retention is strongly associated with mortality rate reduction. Although no studies have documented OUD treatment outcomes specific to AIs, research in Native communities has generally highlighted concerns about the cultural acceptability of the highly directive, Western medical substance-use treatment approaches (e.g., cognitive-behavioral therapy, 12-step programming) that are widely available. Further, previous research has indicated that AIs with substance use disorders want greater representation of Native staff and better integration of culturally adapted approaches in the services they receive. Culturally adapted approaches to treatment are associated with reductions in use and associated problems. However, there are currently no evidence-based, culturally adapted counseling approaches for AIs addressing MAT retention and opioid-related harm. Accordingly, we propose a 2-phase R61/R33 development and evaluation project in response to RFA-DA- 19-013 - “Responding to Opioid Use Disorders (OUD) in Tribal Communities in the Context of SAMHSA and CDC Funding.” This project will leverage recent federal OUD treatment initiative funding (SAMHSA TI-18-016, CDC-RFA-OT18-18030101supp) as a platform for culturally adapting substance-use counseling focused on improving MAT retention and reducing opioid-related harm within the Cherokee Nation Health System (CNHS). The 2-year R61 Phase will entail 2 parts. First, we will conduct a mixed methods inquiry to inform research methods and the community-specific, cultural adaptation of an existing, efficacious, harm-reduction counseling approach. Second, we will manualize and pilot the resulting Counseling for Harm Reduction and Retention in MAT at Cherokee Nation (CHaRRM-CN) together with a community advisory board comprising CNHS providers, staff, and patients as well as researchers from Cherokee Nation, Washington State University, and the University of Washington. The subsequent, 3-year R33 Phase will entail a 2-arm RCT (N=160) conducted within CNHS testing the efficacy of CHaRRM-CN in improving 6-month MAT retention, reducing substance-related harm and illicit opioid use, and increasing Native enculturation compared to a services-as-usual control condition (i.e., cognitive behavioral treatment).