Increasing numbers of opioid overdoses have been observed during the COVID-19 pandemic,
likely reflecting the pandemic's multiple effects on this already vulnerable population.
People in recovery from opioid use disorder (OUD) have reported disproportionate
psychosocial distress and isolation, as well as significant disruptions in access to
treatment including peer support, during the COVID-19 pandemic. These negative outcomes
are especially acute for rural, low-income, and minority populations in recovery from
OUD. Peer support is a key component of many evidence-based OUD recovery programs: it
improves recovery capital, improves treatment engagement, improves perceived social
support, and reduces psychosocial distress, particularly when used in conjunction with
other evidence-based treatments such as medication for opioid use disorder (MOUD). This
grant, submitted in response to PA 20-237, therefore proposes a randomized controlled
trial of a novel mobile peer support app platform among a national sample of 1300
patients in recovery from opioid use disorders (OUDs), as an adjunct to usual care,
during COVID-19. The previously piloted online-only recruitment and follow-up strategy -
in which investigators meld patient-reported outcomes with administrative datasets -
allows strategic recruitment of often-excluded participants from across the United
States, including those facing the highest barriers to treatment. The mobile app-based
peer support intervention, provided as an individual-level enhancement of existing
treatment and recovery programs, will allow individuals in OUD recovery to access a
tailored, anonymous, peer-moderated support group 24/7. The app is augmented with natural
language processing tools capable of automatically 'flagging' critical or clinically
relevant content, thereby creating a scalable system to keep groups safe and
constructive. Participants will be followed for 6 months through both self-report and
administrative outcomes. The study's primary outcome is self-reported recovery capital,
complemented by objectively measured administrative data on retention in treatment
programs from our community and governmental partners in a sub-sample of 650 patients
from RI and IN. Hypothesized secondary outcomes are mitigation of psychosocial effects of
COVID-19 on this vulnerable population, including depressive symptoms, stress, and
loneliness, as well as objective adverse events of emergency department visits and opioid
overdoses. Finally, the investigators will explore whether state- and county-level
variables moderate efficacy. OUD is a major public health problem, and patients in
recovery from OUD are experiencing worse outcomes during the COVID-19 pandemic. If this
mobile app demonstrates efficacy among a large national sample of patients, it has the
potential to augment existing treatment programs, improve recovery capital, and reduce
disproportionate impacts of COVID-19 on this vulnerable population.