Changing our paths: Well-being and recovery among American Indians with opioid use disorder

项目总结 明尼苏达州的美国印第安人(AI)的阿片类药物过量死亡率是其他群体的5-6倍，这一数字 继续上升。药物辅助治疗(Mat)是治疗阿片类药物使用障碍(Oud)的标准。 治疗，但在全国范围内实施和吸收一直很慢，特别是在人工智能社区。因此，在那里 是迫切需要了解多层次障碍和促进者的OUD治疗，包括如何人工智能文化 知识和实践可以交织在OUD治疗中，以及如何提高参与度 沿着《关怀的级联》(CoC)的所有要点。该项目将涉及两国之间的伙伴关系 明尼苏达大学医学院、德卢斯校区和明尼苏达州的一个乡村部落民族。整体而言 本申请的目的是在保留为基础的部落治疗背景下描述OUD COC的特征。 我们的中心假设是，人工智能受益于MAT计划和OUD治疗，但有多个层次 影响COC执行的障碍和促进者，有些是部落社区所特有的。其基本原理是 对于这个项目来说，仔细评估影响OUD COC和AIS的因素将会优化治疗 实施并最终减少与阿片类药物有关的健康不平等现象。R61的筹备目标包括(1) 在部落背景下描述OUD COC的特征并使用以下方法描述其组成部分和过渡点 社区参与性研究(CBPR)方法和现有来源的数据；(2)确定 通过与临床医生的访谈，在关键过渡点与OUD COC接触的障碍和促进者 利益相关者和个人及其家人，以及(3)准备和确认 通过制定和试点研究方案和试验收集观察性纵向数据(R33目标1 措施。R33目标包括：(1)前瞻性地检查治疗的障碍和促进者 初诊MAT后200例AUD患者的参与度和COC定义的临床结果 吸纳评估，以及(2)确定一套以文化为中心、以证据为基础的实施战略 解决障碍并优化整个CoC的治疗参与度。拟议中的项目将利用 并补充部落的SAMHSA部落类阿片反应和MAT处方药和阿片成瘾 资金问题。它是创新的，因为它考虑了部落中整个OUD COC的障碍和促进者 背景，是首批将传播和实施镜头应用于阿片类药物研究的研究之一 人工智能社区。这项研究的预期结果包括以文化为中心的描述 级联关怀与确定的实施战略，以解决参与障碍。调查结果将 提供可推广的科学知识以优化OUD服务，以减少与阿片类药物相关的健康不平等 对美国印第安人来说。

PROJECT SUMMARY American Indians (AI) in Minnesota have 5-6x the opioid overdose death rate of other groups, and this figure continues to rise. Medication-assisted treatment (MAT) is the standard of care for opioid use disorder (OUD) treatment, but implementation and uptake has been slow nationally, especially for AI communities. Thus, there is an urgent need to understand multi-level barriers and facilitators of OUD treatment, including how AI cultural knowledge and practices can be interwoven within OUD treatment and how engagement can be improved along all points of the OUD “Cascade of Care” (CoC). This project will involve a partnership between the University of Minnesota Medical School, Duluth Campus, and a rural Minnesota tribal Nation. The overall objective of this application is to characterize the OUD CoC in a reservation-based, tribal treatment context. Our central hypothesis is that AIs benefit from MAT programs and OUD treatment, but there are multi-level barriers and facilitators that affect implementation of the CoC, some unique to tribal communities. The rationale for this project is that careful assessment of factors influencing the OUD CoC with AIs will optimize treatment implementation and ultimately reduce opioid-related heath inequities. The preparatory R61 aims include (1) characterizing the OUD CoC in a tribal context and delineating its components and transition points using community-based participatory research (CBPR) methods and data from existing sources; (2) identifying barriers and facilitators to engagement with the OUD CoC at key transition points via interviews with clinical stakeholders and individuals with OUD and their families, and (3) preparing and confirming feasibility of observational longitudinal data collection (R33 Aim 1) by developing and piloting study protocols and measures. The R33 aims include: (1) prospectively examining barriers and facilitators to treatment engagement and clinical outcomes defined within the CoC among 200 AIs with OUD after initial MAT clinic intake assessment, and (2) identifying a set of culturally-centered, evidence-based implementation strategies to address barriers and optimize treatment engagement across the CoC. The proposed project will leverage and complement the tribe’s SAMHSA Tribal Opioid Response and MAT Prescription Drug and Opioid Addiction funding. It is innovative because it considers barriers and facilitators across the entire OUD CoC in a tribal context, and is one of the first studies to apply a dissemination and implementation lens to opioid research with AI communities. The expected outcomes of the research include a culturally-centered description of the OUD Cascade of Care with identified implementation strategies to address barriers to engagement. Findings would provide generalizable scientific knowledge to optimize OUD services to reduce opioid-related health inequities for American Indians.