Counseling for Harm Reduction and Retention in Medication-assisted treatment - Cherokee Nation (CHaRRM-CN)

药物辅助治疗中减少伤害和保留的咨询 - Cherokee Nation (CHaRRM-CN)

基本信息

批准号：
10632380
负责人：
Susan E Collins
金额：
$ 64.83万
依托单位：
WASHINGTON STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-08-01 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10632380
关键词：
Abstinence Address American Indians Biochemical Centers for Disease Control and Prevention (U.S.)Cherokee Indian Cognitive Therapy Communities Counseling Data Development Emergency department visit Evaluation Focus Groups Foundations Funding General Population Goals Gold Harm Reduction Health Services Health system High Prevalence Individual Interview Length Medical Methods National Institute of Drug Abuse Opioid Outcome Overdose Overdose reduction Participant Patient Self-Report Patients Phase Positioning Attribute Professional counselor Provider Proxy Public Health Relative Risks Research Research Methodology Research Personnel Services Suboxone Substance Use Disorder Treatment outcome United States Substance Abuse and Mental Health Services Administration Universities Washington Work arm comparative efficacy efficacy testing evidence base experience flexibility follow-up illicit opioid improved marginalized population medication-assisted treatment mortality opioid epidemic opioid mortality opioid overdose opioid use opioid use disorder overdose death patient oriented primary outcome programs response retention rate secondary outcome self reliance services as usual substance use substance use treatment systematic review treatment as usual tribal community

项目摘要

ABSTRACT American Indians (AIs) are disproportionately impacted by the current opioid epidemic. AIs experience an 88% higher prevalence of OUDs (1.5%) than the US general population (0.8%), and AIs are second only to non-Latinx whites in their experience of opioid overdose deaths (13.9 and 17.5 per 100,000, respectively). Fortunately, medication-assisted treatment (MAT; e.g., buprenorphine + naloxone) is highly effective for reducing opioid- related harm, including overdose, making it the gold-standard OUD treatment approach. A recent systematic review, however, showed a median retention of 56% at the NIDA-recommended 12-month treatment length. Further, most AIs with OUD do not attend traditional substance-use treatment (62%). This is concerning because treatment retention is strongly associated with mortality rate reduction. Although no studies have documented OUD treatment outcomes specific to AIs, research in Native communities has generally highlighted concerns about the cultural acceptability of the highly directive, Western medical substance-use treatment approaches (e.g., cognitive-behavioral therapy, 12-step programming) that are widely available. Further, previous research has indicated that AIs with substance use disorders want greater representation of Native staff and better integration of culturally adapted approaches in the services they receive. Culturally adapted approaches to treatment are associated with reductions in use and associated problems. However, there are currently no evidence-based, culturally adapted counseling approaches for AIs addressing MAT retention and opioid-related harm. Accordingly, we propose a 2-phase R61/R33 development and evaluation project in response to RFA-DA- 19-013 - “Responding to Opioid Use Disorders (OUD) in Tribal Communities in the Context of SAMHSA and CDC Funding.” This project will leverage recent federal OUD treatment initiative funding (SAMHSA TI-18-016, CDC-RFA-OT18-18030101supp) as a platform for culturally adapting substance-use counseling focused on improving MAT retention and reducing opioid-related harm within the Cherokee Nation Health System (CNHS). The 2-year R61 Phase will entail 2 parts. First, we will conduct a mixed methods inquiry to inform research methods and the community-specific, cultural adaptation of an existing, efficacious, harm-reduction counseling approach. Second, we will manualize and pilot the resulting Counseling for Harm Reduction and Retention in MAT at Cherokee Nation (CHaRRM-CN) together with a community advisory board comprising CNHS providers, staff, and patients as well as researchers from Cherokee Nation, Washington State University, and the University of Washington. The subsequent, 3-year R33 Phase will entail a 2-arm RCT (N=160) conducted within CNHS testing the efficacy of CHaRRM-CN in improving 6-month MAT retention, reducing substance-related harm and illicit opioid use, and increasing Native enculturation compared to a services-as-usual control condition (i.e., cognitive behavioral treatment).

抽象的美洲印第安人 (AI) 受到当前阿片类药物流行的影响尤为严重，其中 88% 的印第安人受到影响。 OUD 的患病率 (1.5%) 高于美国普通人群 (0.8%)，而 AI 的患病率仅次于非拉丁裔白人因阿片类药物过量死亡的经历（分别为每 10 万人中 13.9 人和 17.5 人）。药物辅助治疗（MAT；例如丁丙诺啡 + 纳洛酮）对于减少阿片类药物非常有效相关危害，包括过量服用，使其成为黄金标准的 OUD 治疗方法。然而，审查显示，按照 NIDA 推荐的 12 个月治疗长度，中位保留率为 56%。此外，大多数患有 OUD 的 AI 不接受传统的药物使用治疗（62％），这是因为。尽管没有研究记录，但治疗保留与死亡率降低密切相关。针对 AI 的 OUD 治疗结果，原住民社区的研究普遍强调了担忧关于高度指导性的西方药物使用治疗方法的文化可接受性（例如，认知行为疗法、12步编程），这些都已广泛应用。已表明，患有药物滥用障碍的人工智能希望原住民工作人员有更多的代表性，并有更好的将适应文化的方法融入到他们接受的服务中。治疗与减少使用和相关问题有关，但是目前还没有。为 AI 提供基于证据、适应文化的咨询方法，解决 MAT 保留和阿片类药物相关问题因此，我们针对 RFA-DA- 提出了一个 2 阶段 R61/R33 开发和评估项目。 19-013 - “在 SAMHSA 和 SAMHSA 的背景下应对部落社区的阿片类药物使用障碍 (OUD) CDC 资金。”该项目将利用最近的联邦 OUD 治疗倡议资金（SAMHSA TI-18-016， CDC-RFA-OT18-18030101supp）作为适应文化的物质使用咨询平台，重点关注改善切罗基国家卫生系统 (CNHS) 内的 MAT 保留并减少与阿片类药物相关的伤害。为期 2 年的 R61 阶段将分为两个部分：首先，我们将进行混合方法调查，为研究提供信息。现有的、有效的、减少伤害的咨询的方法和针对特定社区的文化适应其次，我们将对由此产生的减少伤害和保留咨询进行手动化和试点。 Cherokee Nation (CHaRRM-CN) 的 MAT 以及由 CNHS 提供者组成的社区咨询委员会，来自切罗基民族、华盛顿州立大学和大学的工作人员、患者以及研究人员接下来的 3 年 R33 阶段将需要在 CNHS 内进行 2 组 RCT（N=160）。测试 CHaRRM-CN 在改善 6 个月 MAT 保留、减少物质相关危害和与照常服务的控制条件（即，认知行为治疗）。