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

摘要 美国印第安人(AI)受到阿片使用障碍(OUD)及其相关危害的影响不成比例。 从2019年到2020年，美国印第安人/阿拉斯加原住民的过量死亡率增加了39% (AI/ANS)人口比例为22%，白人为22%。正如目前的环境所表明的那样，阿片类药物相关 人工智能人群之间的差距被放大了。幸运的是，药物辅助治疗(Mat)非常有效。 在减少过量用药和阿片类药物相关伤害方面。尽管MAT是OUD治疗的黄金标准，但它的疗效 取决于治疗保留率。一项系统的审查发现，12个月的中位数保留率为56% 治疗期。这是令人担忧的，因为治疗保留与降低死亡率有关。 在我们的心中。此外，到目前为止，还没有研究分析MAT在人工智能中的有效性 社区。尽管缺乏文献，但研究表明，从那些 受OUD影响是改善物质使用治疗的关键。相应地，一个由美国国立卫生研究院资助的新的CBPR 题为“切罗基族减少伤害和在垫子上保留伤害的咨询”的研究项目(CHaRRM- Cn；R61/R33DA049376；PI：Nelson，Collins，Taylor)，正在参与世界上最大的部落运营的MAT计划 美国将合作为有OUD的人工智能人员改进MAT。在之前的R61阶段，结果已提交给 社区咨询委员会，用于共同开发一个门槛更低、更符合文化和社区驱动的 接近垫子。由此产生的CHaRRM-CN组成部分包括：减少伤害和文化一致性 咨询，提供低门槛垫子服务，监控参与者图表，并增加与 以社区为基础的文化活动。该项目目前的R33阶段将评估 在改善垫子滞留、与物质有关的伤害和非法阿片类药物使用方面产生的组成部分。随后的 多样性补充将在这项工作的基础上展开。艾玛·品川是临床心理学二年级学生 研究生，其职业目标是与使用药物和其他物质的人合作 社区利益攸关方作为独立机构制定和传播循证干预措施 研究员。她建议的补编题为《对 在切诺基民族的垫子上减少和保留伤害咨询的背景(CHaRRM-CN) 美国印第安人药物辅助治疗(MAT)阿片类药物使用障碍(OUD)患者的治疗 将跟踪R33 CHaRRM-CN ARM参与者(N=80)与各种干预组件的接触情况，并 评估是否总体参与CHaRRM-CN组件和/或特定CHaRRM-CN组件 与积极的治疗结果相关。主要治疗结果是垫子固位，继发于 结果是文化联系、与物质相关的伤害和非法阿片类药物-使用本补充剂将 促进品川女士成长为独立调查员，并将以她以前的经验为基础 与受物质使用影响的社区合作。

ABSTRACT American Indian (AI) people are disproportionately impacted by opioid use disorder (OUD) and its related harm. From 2019 to 2020, there was a 39% increase in overdose mortality rates for American Indian/Alaska Native (AI/ANs) people compared to 22% for white people. As evinced by the current OUD milieu, opioid-related disparities are amplified among AI people. Fortunately, medication-assisted treatment (MAT) is highly efficacious in reducing overdose and opioid-related harm. Despite being the gold-standard of OUD treatment, MAT’s efficacy is contingent on treatment retention. A systematic review found a median retention rate of 56% at the 12-month treatment period. This is concerning due to treatment retention being associated with reduced mortality rates within OUD. In addition, there are no studies to date that have analyzed the effectiveness of MAT in AI communities. Despite the dearth of literature, research has indicated that gathering insight from those who are affected by OUD is critical to improving substance-use treatment. Correspondingly, a new NIH-funded CBPR research project entitled, “Counseling for Harm Reduction and Retention in MAT in Cherokee Nation” (CHaRRM- CN; R61/R33DA049376; PIs: Nelson, Collins, Taylor), is engaging the largest tribally run MAT program in the US to collaboratively improve MAT for AI people with OUD. In the prior R61 phase, results were presented to a community advisory board and used to codevelop a lower-barrier, more culturally aligned and community-driven approach to MAT. The resulting CHaRRM-CN components include: harm-reduction and culturally aligned counseling, lower-barrier MAT service provision, monitoring of participant charts, and increasing connection to community-based cultural events. The current R33 phase of this project will assess the effectiveness of the resulting components in improving MAT retention, substance-related harm, and illicit opioid use. The subsequent diversity supplement will expand upon this work. Emma Shinagawa is a second-year clinical psychology graduate student whose career goal is to work collaboratively with people who use substances and other community stakeholders to develop and disseminate evidence-based interventions as an independent researcher. The supplement she proposes titled Perceptions and Relative Contributions of Components in the Context of the Counseling for Harm Reduction and Retention in MAT with Cherokee Nation (CHaRRM-CN) Treatment for American Indian Medication Assisted Treatment (MAT) Patients with Opioid Use Disorder (OUD) will track the R33 CHaRRM-CN arm participants’ (N=80) engagement with various intervention components and evaluate whether overall engagement to CHaRRM-CN components and/or specific CHaRRM-CN components is associated with positive treatment outcomes. The primary treatment outcome is MAT retention with secondary outcomes being cultural connectedness, substance-related harm and illicit opioid-use This supplement will facilitate Ms. Shinagawa’s development into an independent investigator and will build upon her prior experience working with communities impacted by substance use.