Opioid Use
Conditions
Keywords
Medications for opioid use disorder, Peer recovery coach, Substance use, Behavioral activation, Task sharing, Treatment retention
Brief summary
This project aims to implement a peer-led intervention to support retention and adherence to medications for opioid use disorder among low-income adults in Detroit, as well as a training manual for peer recovery coaches serving similar populations. The approach will serve as a guide to coaches in providing positive reinforcement and helping those in treatment to schedule and engage in valued activities. Researchers will examine the effectiveness of the intervention, supervision and training models, and share results with policymakers and treatment programs.
Detailed description
Low-income and racial/ethnic minorities suffer disproportionately from the opioid use disorder (OUD) crisis, evidencing consistently lower rates of critical treatment outcomes, including medication for OUD (MOUD) engagement and retention. While these individuals exhibited a need for evidence-based care prior to the pandemic, low-income, racial/ethnic minority populations have been disproportionately affected by COVID-19, as have persons with SUDs. Peer Recovery Coaches (PRC) are individuals with lived-experiences with substance use who have been certified by the state to assist in treatment recovery. Because of similarities between PRCs and substance use clients, PRCs can overcome many of the barriers that clients face to engaging and staying in MOUD treatment, such as stigma. goal of the current project is to conduct an open-label pilot trial to examine the feasibility, acceptability and accessibility of a PRC-led intervention to support retention in MOUD care. This project proposes to develop a novel and sustainable model for improving retention in MOUD treatment by training PRCs to deliver an evidence-based intervention (EBI), Behavioral Activation (BA). BA seeks to increase the positive reinforcement patients experience from their natural environment by promoting prosocial and valued experiences. BA has been found to improve substance use treatment retention and adherence, as well as medication adherence in low-income individuals with HIV/AIDS. To that end, the following goal is proposed: to evaluate the preliminary feasibility, acceptability, and effectiveness of the PRC- delivered BA approach. An open-label pilot trial (n=40) of the adapted PRC-delivered BA intervention and training protocol in a representative agency in Detroit, MI serving a low-income, predominantly African-American population will be conducted. Findings from this phase of the project will be used to re-adapt the manual and training procedures.
Interventions
BEHAVIORALBehavioral Activation (BA)
BA seeks to increase the positive reinforcement patients experience from their natural environment by promoting prosocial and valued experiences. BA has been found to improve substance use treatment retention and adherence, as well as medication adherence in low-income individuals with HIV/AIDS.
Sponsors
University of Maryland, College Park
Henry Ford Health System
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Participants must (1) be receiving or referred to MOUD; and (2) be over the age of 18.
Exclusion criteria
*
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| MOUD Retention Rate | Measured between participants' completion of baseline assessment and completion of the follow-up assessment (approximately 8-12 weeks following the intervention date). | Average number of days a participant missed an MOUD appointment between receiving the intervention and completing the follow-up assessment (approximately 8-12 weeks following the intervention date), averaged across all participants with available data. |
| Intervention Fidelity: Proportion of Intervention Components Delivered as Intended | The number of days between starting the intervention and completing the intervention (approximately 8-10 weeks). | Defined as the proportion of all 24 intervention components in the total intervention that were delivered with fidelity by the interventionist (ranging from 0 to 1.0 with higher proportion reflecting more fidelity). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intervention Acceptability: Percentage of Patients Enrolled Who Attend ≥75% Sessions | The number of days between starting the intervention and completing the intervention (approximately 8-10 weeks). | Defined as the percentage of participants who started the intervention who then finish the intervention (defined as completing 8 total sessions) |
| Intervention Feasibility: Percentage of Patients Who Consents Who Started BA | The number of days between starting providing consent and starting BA (approximately 1-5 weeks). | Defined as the percentage of participants who started BA sessions relative to those who enrolled in the program |
Countries
United States
Participant flow
Recruitment details
Participants were enrolled via flyers and word-of-mouth at a community-based substance use treatment setting from December 2021 through April 2023.
Participants by arm
| Arm | Count |
|---|---|
| Peer-delivered Behavioral Activation Adults 18 years or older on MOUD or referred to MOUD will receive Behavioral Activation (BA) an evidence-based intervention (EBI) by trained Peer Recovery Coaches (PRC)
Behavioral Activation (BA): BA seeks to increase the positive reinforcement patients experience from their natural environment by promoting prosocial and valued experiences. BA has been found to improve substance use treatment retention and adherence, as well as medication adherence in low-income individuals with HIV/AIDS. | 29 |
| Total | 29 |
Baseline characteristics
| Characteristic | Peer-delivered Behavioral Activation |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 1 Participants |
| Age, Categorical Between 18 and 65 years | 28 Participants |
| Age, Continuous | 46.6 Years STANDARD_DEVIATION 13.6 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 26 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 25 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants |
| Race (NIH/OMB) White | 2 Participants |
| Region of Enrollment United States | 29 participants |
| Sex: Female, Male Female | 10 Participants |
| Sex: Female, Male Male | 19 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 1 / 29 |
| other Total, other adverse events | 0 / 29 |
| serious Total, serious adverse events | 0 / 29 |
Outcome results
Primary
Intervention Fidelity: Proportion of Intervention Components Delivered as Intended
Defined as the proportion of all 24 intervention components in the total intervention that were delivered with fidelity by the interventionist (ranging from 0 to 1.0 with higher proportion reflecting more fidelity).
Time frame: The number of days between starting the intervention and completing the intervention (approximately 8-10 weeks).
Population: Fidelity was examined among participants who took part in at least one BA session.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Peer-delivered Behavioral Activation | Intervention Fidelity: Proportion of Intervention Components Delivered as Intended | .83 proportion of elements delivered | Standard Deviation 0.09 |
Primary
MOUD Retention Rate
Average number of days a participant missed an MOUD appointment between receiving the intervention and completing the follow-up assessment (approximately 8-12 weeks following the intervention date), averaged across all participants with available data.
Time frame: Measured between participants' completion of baseline assessment and completion of the follow-up assessment (approximately 8-12 weeks following the intervention date).
Population: We were able to get data on MOUD visits from 18 participants from the total sample.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Peer-delivered Behavioral Activation | MOUD Retention Rate | .42 number of days missed MOUD appointment | Standard Deviation 2.86 |
Secondary
Intervention Acceptability: Percentage of Patients Enrolled Who Attend ≥75% Sessions
Defined as the percentage of participants who started the intervention who then finish the intervention (defined as completing 8 total sessions)
Time frame: The number of days between starting the intervention and completing the intervention (approximately 8-10 weeks).
Population: We examined the percentage of all participants who started the intervention who then completed the intervention (defined as taking part in 8 sessions)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Peer-delivered Behavioral Activation | Intervention Acceptability: Percentage of Patients Enrolled Who Attend ≥75% Sessions | 62 percentage of participants |
Secondary
Intervention Feasibility: Percentage of Patients Who Consents Who Started BA
Defined as the percentage of participants who started BA sessions relative to those who enrolled in the program
Time frame: The number of days between starting providing consent and starting BA (approximately 1-5 weeks).
Population: We examined the percentage of participants who took part in at least one BA session relative to those who enrolled.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Peer-delivered Behavioral Activation | Intervention Feasibility: Percentage of Patients Who Consents Who Started BA | 21 Participants |