Young people are disproportionately affected by the current opioid crisis including worse
retention and outcomes compared to older adults. Further, young adults typically do not
have access to medications for opioid use disorder (OUD), and for those that do,
struggles with adherence are a major barrier. Standard approaches to treatment typically
do not incorporate developmentally informed strategies for engagement, retention, and
medication adherence for this special population.
The Youth Opioid Recovery Support (YORS) model is an innovative wrap-around approach that
attempts to address barriers to treatment engagement in this vulnerable young adult
population, especially difficulties with medication adherence. Its components include:
(1) Home delivery of extended release naltrexone (XR-NTX) for OUD; (2) Engagement of
families in collaborative treatment planning and monitoring focusing on medication
adherence; (3) Assertive outreach from the treatment team including actively tracking and
communicating with youth and families by text messaging and social media to promote
engagement and adherence; and (4) Contingency management to provide incentives for
medication adherence. YORS is currently showing very promising results in a small pilot
randomized clinical trial (RCT) by the investigative team.
The investigators propose to refine and then conduct a more definitive test of the YORS
intervention for youth with OUD. In the first phase the investigators will conduct
stakeholder focus groups to get input and feedback on potential refinements, while also
conducting 3 cycles of pilot testing of these potential refinements. Based on the
preparation and final synthesis of the intervention refinements, in the second phase the
investigators will conduct an RCT to test the efficacy of YORS, by randomizing N=120
young adults ages 18-26 seeking treatment for OUD with XR-NTX at Mountain Manor Treatment
Center (MMTC), to either the refined YORS intervention or treatment as usual (TAU) for a
6-month course of treatment with XR-NTX.
The primary outcome will be number of XR-NTX doses received. Secondary outcomes will
include opioid relapse, days of opioid use, time to first opioid relapse, HIV risk
behaviors, criminal behaviors, psychiatric symptoms, and family member distress and
self-efficacy. It is hypothesized that participants in the YORS condition will receive
significantly more XR-NTX doses and will demonstrate less severe opioid use and
associated behaviors compared to those in the TAU group. The assertive YORS intervention
has the potential to improve the real-world effectiveness and public health impact of
medication for OUD in this very high-risk, vulnerable population. If the refined YORS
intervention is found to be efficacious, it would set the stage for future work
including: an economic analysis, a larger multi-site study, longer intervention duration,
study of extended release buprenorphine, and study of step-down to less intensive
interventions.