Understanding the Impact of COVID-19 on Methadone Treatment Retention and Adherence in an Underserved, Minority Population with OUD

PROJECT Summary: The opioid use disorder (OUD) crisis in the US is an epidemic of poor access to care, including medication foropioid use disorder (MOUD) and evidence-based behavioral interventions to support MOUD outcomes. Low-income, racial/ethnic minority individuals with OUD disproportionately evidence poor MOUD outcomes,including less than half of individuals typically being retained in MOUD at six months. Retention is one of thefactors most predictive of future relapse, functioning, and mortality. Implementing evidence-based interventionsto improve MOUD retention that are particularly appropriate for the needs of low-income, racial/ethnic minorityindividuals with OUD is essential. Peer recovery coaches (PRCs), trained individuals with their own livedexperience with substance use disorder, may be uniquely suited to address common barriers to MOUDretention among underserved populations, including stigma, challenges navigating services, housing instability,other structural and psychosocial factors. PRC-delivered interventions are a promising strategy for improvingMOUD retention for low-income, minority individuals with OUD, yet there are few evidence-based interventions(EBIs) that have been evaluated for PRC delivery to promote MOUD retention. Preliminary work by our teamsuggests that behavioral activation (BA) may be a feasible, scalable reinforcement-based approach forimproving MOUD retention for low-income, minority individuals with OUD by PRCs. The proposed study buildsupon our team's formative work to adapt and evaluate the effectiveness and implementation of a PRC-deliveredBA intervention (Peer Activate) to support MOUD retention for low-income, minority individuals initiating MOUD inBaltimore City, which has one of the highest overdose-fatality rates in the US and greatest burdens of OUDamong low-income, racial/ethnic minority individuals. In Phase 1, we propose to refine and finalize the PRC-delivered Peer Activate model and address barriers to implementation for Phase 2 using pre-intervention focusgroups with PRCs, staff, clients, and other key stakeholders (n=24). We will establish the preliminary feasibility,acceptability and fidelity of Peer Activate in an open-label trial (n=30) and pilot Phase 2 study procedures,including collecting preliminary MOUD outcomes (MOUD retention and opioid abstinence at 3 months). Basedupon adaptations in Phase 1, we will then conduct a randomized, Type 1 hybrid effectiveness-implementationtrial to evaluate the effectiveness and implementation of Peer Activate vs. treatment as usual (TAU; n=200) onMOUD retention at six months (primary), MOUD adherence and opioid abstinence (urine toxicology), anddepressive symptoms (secondary). Implementation outcomes will be assessed at multiple levels (patient,provider, organization), including assessments of feasibility, acceptability, fidelity, and adoption guided byProctor's conceptual model of implementation outcomes. Our multidisciplinary team aims to develop anevidence-based PRC-delivered treatment model that can be sustainably delivered to improve MOUD retentionfor low-income, minority individuals with OUD.