Background: The opioid use disorder (OUD) crisis is an epidemic of poor access to care, including lack of access to evidence-based behavioral interventions alongside medication for OUD. Peer recovery specialists (PRSs) are trained individuals with their own lived experience with substance use disorder. PRSs may be uniquely suited to address common barriers to MOUD retention among underserved populations, including stigma, challenges navigating services, housing instability, as well as other structural and psychosocial factors. This project aims to evaluate how PRS-delivered behavioral activation (BA) intervention can improve retention in care for underserved, minoritized individuals with OUD.
Study design: This Type 1 hybrid effectiveness-implementation randomized controlled trial (RCT) builds upon our team’s formative work to adapt and evaluate a PRS-delivered BA intervention (Peer Activate) to support MOUD retention for low-income, minoritized individuals initiating MOUD in Baltimore City, which has one of the highest overdose-fatality rates in the US and greatest burdens of OUD among underrepresented individuals.
In this two-phase, five-year project as part of the NIH HEAL Initiative and in close collaboration with University of Maryland Baltimore (UMB) Psychiatry, we will evaluate the effectiveness and implementation of the Peer Activate intervention delivered to patients enrolled in the methadone treatment program at the University of Maryland Drug Treatment Center (n = 100) compared to patients receiving treatment as usual at the program (TAU; n=100).
Aims: We will evaluate the effectiveness and implementation of Peer Activate on MOUD retention at six months (primary), MOUD adherence and substance use changes (urine toxicology), and depressive symptoms (secondary). Implementation outcomes will be assessed at the patient, provider, organization levels, including assessments of feasibility, acceptability, fidelity, and adoption guided by Proctor’s conceptual model of implementation outcomes. The overall goal of this work is to develop an evidence-based PRS-delivered treatment model that can be sustainably delivered to improve MOUD retention for low-income, minority individuals with OUD.
Location: Baltimore, Maryland
Funding: NIH HEAL Initiative (R61AT010799, R33DA057747B)
Principal Investigator: Jessica Magidson
Partners/collaborators: University of Maryland, Baltimore
Opportunities: Staff and graduate students can be involved in study coordination, data collection, qualitative analyses, and secondary data analysis.
Publication of results:
- ASCP/AHSR: Peer recovery specialist-delivered, behavioral activation intervention to improve retention in methadone treatment: Results from an open-label, Type 1 hybrid effectiveness-implementation pilot trial
- ASCP/AHSR: Syndemic barriers to successful treatment outcomes for individuals receiving medication for opioid use disorder
- ASCP/AHSR: Defining patient-centered successful methadone treatment outcomes among low-income, minority individuals at a community-based outpatient treatment center
- ASCP/AHSR: Adapting a peer-delivered Behavioral Activation intervention to support retention in methadone maintenance treatment for a low-income, minority population
- NIH: "Sometimes you have to take the person and show them how": adapting behavioral activation for peer recovery specialist-delivery to improve methadone treatment retention