R01DA057443

Peer-Delivered, Behavioral Activation Intervention to Improve Polysubstance Use and Retention in Mobile Telemedicine OUD Treatment in an Underserved, Rural Area - Background

More than 50% of rural counties in the US do not have a single buprenorphine-waived provider, and approximately 10% of people in the US live more than 10 miles away from their nearest prescriber. Compounding the devastating effects of the opioid use disorder (OUD) crisis in underserved, rural areas is increasing polysubstance use, notably stimulant use disorder co-occurring with OUD.

Since 2019, our team has filled a void of rural addiction treatment practitioners in underserved rural Maryland areas by providing buprenorphine for OUD treatment with the use of telemedicine (TM) aboard a mobile treatment unit (MTU). Our team has demonstrated the effectiveness of the TM-MTU model in reducing opioid use by 32.8% at three months. Yet, 92% of patients in the past year presented with polysubstance use at intake, approximately half with OUD and stimulant use. Further, treatment retention is a challenge, amplified by polysubstance use; less than 60% of patients were retained at three months.

Reinforcement-based approaches, such as contingency management, have empirical support for improving treatment retention and stimulant use, yet have low adoption in community settings due to organizational and provider barriers, including cost. A behavioral reinforcement-based approach, such as behavioral activation (BA), which aims to increase positive reinforcement through rewarding, substance-free behaviors, may be a promising effective and sustainable strategy to improve both OUD treatment retention and polysubstance use, particularly stimulant use. Further, our team has demonstrated that it is feasible to train peer recovery specialists (PRSS) in BA.

Preliminary Studies

This proposal builds upon our team's prior studies demonstrating the feasibility, acceptability, and effectiveness of:

1) The TM-MTU model reaching rural communities hard hit by the OUD crisis and polysubstance use;
2) Integrating PRS support on the TM-MTU; and
3) A PRS-delivered BA intervention ("Peer Activate") for improving treatment retention and reducing polysubstance use, including OUD and stimulant use.

Approach

Building upon this work, we propose a randomized Type 1 hybrid effectiveness-implementation trial (N=180) to evaluate the PRS-delivered BA intervention on the MTU (Peer Activate-MTU) compared to enhanced treatment as usual (ETAU; facilitated referrals and general peer support) on the following over 12 months:

1) Effectiveness outcomes:
a) OUD treatment retention (primary: chart review of appointment attendance);
b) Polysubstance use (co-primary: urinalysis of co-occurring use of ≥2 substances); and
c) Buprenorphine adherence (secondary: urinalysis and pharmacy refill).

2) Implementation outcomes, including feasibility, acceptability, fidelity, and adoption guided by RE-AIM.

3) Cost of implementing and sustaining Peer Activate-MTU and its economic value relative to ETAU.

Implications

This proposal is designed to lead to a potentially scalable model for improving OUD treatment retention and polysubstance use, particularly co-occurring OUD and stimulant use, and increasing the reach of addiction treatment in underserved, rural areas.

College Park University Of Maryland

TO SUPPORT BASIC AND CLINICAL NEUROSCIENCE, BIOMEDICAL, BEHAVIORAL AND SOCIAL SCIENCE, EPIDEMIOLOGIC, HEALTH SERVICES AND HEALTH DISPARITY RESEARCH. TO DEVELOP NEW KNOWLEDGE AND APPROACHES RELATED TO THE PREVENTION, DIAGNOSIS, TREATMENT, ETIOLOGY, AND CONSEQUENCES OF DRUG ABUSE AND ADDICTION, INCLUDING HIV/AIDS. TO SUPPORT RESEARCH TRAINING AND RESEARCH SCIENTIST DEVELOPMENT. TO SUPPORT DISSEMINATION OF RESEARCH FINDINGS. SMALL BUSINESS INNOVATION RESEARCH (SBIR) LEGISLATION IS INTENDED TO EXPAND AND IMPROVE THE SBIR PROGRAMS TO EMPHASIZE AND INCREASE PRIVATE SECTOR COMMERCIALIZATION OF TECHNOLOGY DEVELOPED THROUGH FEDERAL SBIR RESEARCH AND DEVELOPMENT, INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN THE SBIR PROGRAM. THE LEGISLATION INTENDS THAT THE SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.279 - Drug Abuse and Addiction Research Programs

National Institute on Drug Abuse (NIDA) [HHS - NIH]

College Park, Maryland 207425103 United States

Single Zip Code

HEAL Initiative: Understanding Polysubstance Use and Improving Service Delivery to Address Polysubstance Use (R01 Clinical Trial Optional) (RFA-DA-22-047)

Amendment Since initial award the End Date has been extended from 09/29/25 to 08/31/27 and the total obligations have increased 46% from $2,357,873 to $3,434,019.