R01DA057591

Preferences and Predictors Driving Opioid-Involved Polysubstance Use Profiles and Trajectories: Implications for Improving Care - Project Summary/Abstract

Recent changes in overdose mortality are driven by rapid increases in polysubstance-involved deaths, most often including opioids followed by stimulants. Prior studies have found important individual (e.g., Black/African American race, comorbid mental/physical health), social (e.g., family supports), and community factors (e.g., treatment availability) associated with polysubstance use (PSU), treatment, and outcomes. However, little is known about the modifiable individual-level motivators (e.g. use to alleviate withdrawal) and preferences driving high-risk PSU behaviors (e.g., intravenous use, higher frequency of opioid-involved PSU, intentional use of synthetic opioids, and simultaneous use of substances), which is important to inform and tailor treatment services.

Behavioral Economic (BE) theory provides a novel framework and objective measures to understand substance use preferences, emphasizing substance use is impacted by drug valuation (i.e., demand) and devaluing of uncertain negative outcomes (e.g., overdose risk) in complex environments and can inform clinical care. This is especially critical given that people with opioid-involved PSU are among the least likely to receive effective overdose prevention or treatments. As we have shown, although >85% of people who died from opioid, stimulant or alcohol-involved overdose are seen in healthcare settings (e.g., primary and mental health care), only a tiny fraction receive effective care, suggesting new strategies are needed that can be implemented in health systems, an important common touchpoint for this population.

Data are critically needed to understand these intricate individual-level patterns, motivators and preferences driving PSU, along with known community and social factors, to improve care for people with opioid-involved PSU. We will conduct a prospective cohort study (N=400), recruiting a diverse sample of adults with opioid-involved PSU (over-sampling stimulant co-use and Black/African Americans to enhance representation) from 2 large health systems in Michigan. Following baseline enrollment, we will collect weekly detailed data to reliably capture nuanced and dynamic patterns and motivators of use and co-use (e.g., simultaneous or sequential, overdose risk behaviors, etc.) over four weeks.

Additional measures across baseline, 4-, 8-, and 12-months (e.g., behavioral economic choice preferences, comorbid mental/physical health, functioning, other social and community factors, and treatment use) will provide comprehensive information on profiles and longitudinal trajectories of PSU behaviors and treatment. Cohort data will be complemented by stakeholder interviews to elucidate patient and provider perspectives on PSU and how to tailor strategies (e.g., naloxone and low-barrier MOUD treatment) to enhance uptake.

This project will have high public health impact by providing critical new insights on motives and patterns of PSU, BE choice preferences across PSU profiles, as well as nuanced patterns and trajectories of PSU and treatment to inform actionable strategies that can be implemented in health systems to improve health and outcomes across the diverse population of people with PSU.

Regents Of The University Of Michigan

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]

Ann Arbor, Michigan 481091276 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 33% from $2,339,396 to $3,119,296.