Over 100,000 lives were lost due to drug overdose in the past year, of which 80% involved
opioids.The majority of opioid-related deaths were due to fentanyl, an illicit opioid
that has been labeled the single deadliest drug threat ever encountered in the United
States.With opioid overdose deaths doubling in the past two years, there are no current
signs that the epidemic is slowing down. Despite the effectiveness of medications for
opioid use disorder (MOUD) at reducing opioid use, only 10% of those in need receive
treatment. Furthermore, treatment retention is low (30-50%). Low treatment initiation and
retention rates for Opioid Use Disorder (OUD) are especially concerning for rural and
underserved communities, who rarely have access to clinicians prescribing MOUD and
experience substantial barriers to care, including lack of insurance, social isolation,
homelessness, transportation issues, and stigma. Given these populations are also at an
elevated risk of overdose due to many of these same factors,interventions to increase
MOUD initiation, retention, and overdose prevention in rural and underserved communities
are urgently needed.
Our proposal aims to improve medication for opioid use disorder (MOUD) treatment rates
and prevent overdose deaths in underserved communities using mobile health clinics (MHC).
This will be achieved by developing, testing, delivering, and evaluating two key
components: 1) a Peer Support Specialist (PSS) intervention to enhance MOUD initiation
and retention, and 2) a modeling framework to identify high-risk communities for MHC
delivery of opioid use disorder (OUD) interventions, based on the prevention of overdose
deaths in those areas. Previous research has shown that such modeling tools can
significantly enhance the efficiency of resource allocation across different health
issues.
In the initial R61 phase, we will develop the PSS intervention and modeling framework.
The primary goal of aim 1 in the R61 phase is to assess the early fidelity,
acceptability, and effectiveness of the PSS Service Delivery in boosting MOUD initiation
and retention in rural and underserved populations. This intervention will draw from the
successful assertive community engagement (ACE) model PSS interventions for substance use
disorders and will be crafted based on qualitative interviews with PSS and OUD patients,
as well as pilot data.