Mechanisms of Action of Peer Recovery Support for People Receiving Opioid Use Disorder Treatment

About This Grant

Abstract The proposed K99/R00 award aims to guide the applicant to research independence, specifically in mechanisms of action (MoA) research of recovery support services for substance use disorders. The opioid epidemic is an ongoing public health crisis with opioid-related overdose deaths continuing to rise. Although there are effective treatments for opioid use disorder (OUD; e.g., medication-assisted treatment), many patients drop out of treatment too early to realize the effects of these interventions. Peer recovery support (PRS) is a promising tool to improve treatment retention for individuals with OUD; however, the mechanisms underlying PRS remain unknown. This study seeks to partner with individuals impacted by the opioid epidemic to develop: 1) a client- centered assessment battery of MoA underlying PRS; and 2) an MoA-enhanced PRS program designed to enhance mechanisms responsible for increasing retention in OUD treatment. During the K99 phase, the PI, in collaboration with two community boards of 1) individuals with lived experience with OUD and 2) certified PRS specialists (certified “peers”) who support people in treatment for OUD, will identify potential MoA and compile appropriate assessments of those MoA (Aim 1a). Next, using iterative mixed methodology, the assessment battery will be iteratively refined (Aim 1b) through two waves of qualitative interviews informed by human- centered design principles (n = 10) and think-aloud protocols (n = 10). Following refinement of the battery, these assessments will be incorporated into an ongoing clinical trial to examine effects of a PRS program on these MoA (N = 82; Aim 2). MoA with the largest effects will then be incorporated into an MoA-enhanced PRS program co-developed with community boards (Aim 3). During the R00 phase, feasibility and acceptability of the MoA- enhanced PRS program will be evaluated in a randomized controlled trial (RCT) comparing this program plus standard care to standard care only (Aim 4) in a sample of patients initiating treatment for OUD (N = 70). Preliminary efficacy signals related to the impact of the PRS program on treatment retention and opioid use will be examined as an exploratory aim. The training and career development plan includes courses, workshops, seminars, readings, and hands-on research in areas critical to the PI’s independence: mixed methods design and data analysis including human-centered design and qualitative interviewing, principles and methods of community-based participatory research, skills to develop novel peer recovery support services in community settings, examining feasibility, acceptability, early signs of efficacy, and MoA in RCTs, and transition to independence in research through training in grants management, grant writing, scholarly writing, and scientific presentations. The R00 project will provide pilot data to support future R01 applications for fully-powered efficacy trials of the MoA-enhanced PRS program. This K99/R00 award will set the foundation of the PI’s independent research career, specializing in MoA for behavioral interventions.