New Mexico Clinical Trials Node: Clinical research and practice to address substance use in diverse, rural and underserved populations

As early as February of 2020, American Indian and Alaska Native (AI/AN) communities began to reportincreased prevalence rates of COVID-19 relative to the rest of the US. Compared to non-NHWs (21%), 34%of AI/AN adults are at greatest risk of COVID-19 related serious illness. AI/AN adults are also more likely tosuffer from underlying health conditions that further increases vulnerability to COVID-19 infection, such asdiabetes, cardiovascular disease, and cancer. These elevated risks are exacerbated by historical and politicalfactors, including population collapses from smallpox and the Spanish flu, low socioeconomicstatus, obstacles to accessing needed care and chronic underfunding of the Indian Health Service. Tovividly illustrate COVID-19-related disparities, AI/AN people comprise ~11% of the New Mexico population, yetaccount for more than 55% of COVID-19 cases in the state,10 with the Navajo Nation reporting 3,912 confirmedcases and 140 deaths (as of 5/21/20). To address the treatment needs of people with substance use disorders,especially opioid use disorder (OUD), during the COVID-19 emergency, federal regulations guiding addictionservices delivery have been modified, including within AI/AN communities. Changes include expansionof telemedicine and virtual behavioral health delivery, adjusting medication dosing strategies for OUD, andaltering reimbursement and confidentiality policies and practices for addiction services. Although these policyshifts were to promote availability and access, little is known about the adoption, implementation, andeffectiveness of these changes among programs serving AI/AN communities. Data is critically needed to informpolicy decisions following the COVID-19 emergency - that is, should policies be further developed andexpanded or, alternatively, rolled back. In order to ensure future policies decisions about addiction serviceinclude experiences and needs of AI/AN communities, rapid research on the dissemination, adoption, andimplementation of federal addiction policies among AI/AN-serving addiction treatment programs is of vitalimportance. The goal of this study is to rapidly investigate the dissemination, adoption, implementation, andsustainment of substance use and COVID-19 related policy changes among Tribal communities.The specific aims are to assess the dissemination, adoption, and implementation of COVID-19 policy and regulations at Tribal, State, and Federal levels by including quantitative questions to theCTN0096-1a National Tribal Addiction Survey (n=300) and examine the implementation and outcomes ofCOVID-19 policy and regulation changes at the Tribal, State, and Federal levels through qualitative interviewsconducted among providers and consumers (n=50).