Background: There is a significant burden of opioid and polysubstance use, disproportionately affecting underserved, in rural areas of the US. Yet many rural communities are poorly equipped to meet the pressing need for addiction treatment, including medications for OUD (MOUD) and evidence-based interventions (EBIs) to address the rise in opioid use disorder (OUD) and co-occurring stimulant use. The availability of telemedicine aboard a mobile treatment unit (TM-MTU), led by University of Maryland Baltimore in partnership with Maryland Department of Health, has helped fill the void of rural practitioners by providing buprenorphine for OUD treatment in rural areas, however, OUD treatment retention remains an ongoing challenge, with polysubstance use and stimulant use exacerbating this. Peer recovery specialists (PRSs), trained individuals with their own lived experience with substance use disorder (SUD) and recovery, are a promising strategy to improve OUD treatment retention and polysubstance use via the TM-MTU using a reinforcement-based approach, such as behavioral activation (BA).  

Study design: This type 1 hybrid effectiveness-implementation trial (N = 180) aims to evaluate the effectiveness, implementation, and cost-effectiveness of an adapted PRS-delivered BA approach on the TM-MTU (“Peer Activate-MTU”) compared to enhanced treatment as usual for patients with OUD and other polysubstance use. Peer Activate-MTU is a brief, six-session intervention, with six additional optional “booster” sessions to reinforce intervention content. Participant outcomes will be followed-up on for approximately one-year following enrollment in the study.  

Aims: This study aims to evaluate a peer-delivered behavioral activation intervention delivered on a mobile treatment unit (Peer Activate-MTU) in rural Maryland compared to enhanced treatment as usual over 12 months. Primary outcomes are polysubstance use (effectiveness), implementation outcomes (guided by RE-AIM), and cost-effectiveness. As a secondary outcome we will assess retention in OUD treatment.  

Location: Eastern Shore of Maryland 

Funding: NIDA (R01DA057443; 2022-2027) 

Principal Investigators: Sarah Kattakuzhy, Jessica Magidson 

Partners/collaborators: University of Maryland, Baltimore 

Opportunities: Staff and graduate students can be involved in study coordination, primary data collection, secondary data analysis, and future grant submissions. 

Article:

Roads to Recovery
In Rural Maryland, a New ‘Been-There-Done-That’ Approach to the Opioid Crisis Offers Hope on Four Wheels