R01DA057655

Implementing and Evaluating the Impact of Novel Mobile Harm Reduction Services on Overdose Among Women Who Use Drugs: The SHOUT Study - Project Summary

Nearly 92,000 Americans died of drug overdoses in 2020, primarily driven by a lethal drug supply dominated by synthetic opioids (i.e., fentanyl and fentanyl analogs) and increased stimulant-related deaths. We have documented the magnitude of this epidemic experienced by women who use drugs (WWUD) (N=385) in Baltimore City, who reported high rates of experiencing an overdose (28%), witnessing a fatal overdose (35%), and witnessing a non-fatal overdose (52%) in the past 6 months.

We have also documented a number of structural vulnerabilities (i.e., homelessness, hunger), mental health morbidities (i.e., PTSD, depression), interpersonal violence, and chaotic drug use patterns (i.e., polysubstance use) that indirectly and directly drive women's distinct risk of overdose and other morbidities (i.e., HIV, HCV). Yet, WWUD experience numerous barriers to receiving necessary medical and behavioral services that can reduce their risk of overdose and other harms, with barriers amplified by the COVID-19 pandemic.

We propose conducting the SHOUT (Sustained Harm Reduction Outreach) Study, a Type 1 hybrid effectiveness-implementation design to evaluate the impact and implementation of WWUD-centered, mobile harm reduction services on nonfatal overdose and clinical care engagement among WWUD (N=400) recruited from Baltimore City and County neighborhoods new to Mobile SPARC services. Mobile SPARC is an existing low-barrier, outreach program serving other neighborhoods and offers harm reduction supplies (i.e., sterile syringes, naloxone, condoms), necessities (i.e., food, clothing), trauma-informed micro-counseling, and necessary referrals.

The study aims to:

1) Adapt and expand Mobile SPARC's services to identify predisposing (i.e., drug use patterns) and enabling (i.e., access to trusted health services) factors that facilitate or hinder utilization of harm reduction services, employing in-depth interviews with WWUD (N=40) and key informant interviews with Mobile SPARC staff (N=5).
2) Evaluate the impact of expanding Mobile SPARC on nonfatal overdose and clinical service engagement (including drug treatment) over 18 months among WWUD (N=400) recruited from neighborhoods in which Mobile SPARC will be newly implemented.
3) Characterize the implementation of Mobile SPARC using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to inform future implementation and scale-up.

The SHOUT Study will make a significant contribution to the literature in evaluating the impact of tailored, low-barrier mobile outreach on overdose among WWUD. The study's relevance and sustainability will be enhanced through its partnership with SPARC, input from a Community Advisory Board, and support of long-term collaborating organizations and health department stakeholders, as well as the cost-effectiveness analysis.

This proposal is highly responsive to the RFA DA-22-046's emphasis on replicable harm reduction service delivery models targeting underserved populations at high risk of overdose.

The Johns Hopkins University

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]

Baltimore, Maryland 212182608 United States

Single Zip Code

HEAL Initiative: Harm Reduction Policies, Practices, and Modes of Delivery for Persons with Substance Use Disorders (R01 Clinical Trial Optional) (RFA-DA-22-046)

Amendment Since initial award the End Date has been extended from 09/29/25 to 07/31/27 and the total obligations have increased 32% from $2,289,649 to $3,024,580.