Peer recovery support for people experiencing homelessness with opioid use disorder

PROJECT SUMMARY / ABSTRACT People experiencing homelessness (PEH) are disproportionately affected by the opioid overdose crisis, with overdose rates up to 30-times higher than the general population. Medications for opioid use disorder (OUD) substantially reduce mortality, but retention in treatment remains low. Identifying strategies to improve OUD treatment retention in this population is crucial to enhancing recovery opportunities and reducing mortality. Peer recovery support has shown promise in improving OUD treatment outcomes in the general population, but research studying its effects has been limited by a lack of attention to vulnerable populations (e.g., PEH), heterogeneity in the services provided, and lack of methodologic rigor in study design. This award addresses all of these gaps and will advance the science of peer recovery support for the treatment of OUD among PEH. Using a community-engaged framework and a mixed methods design, the investigators will (1) develop a peer recovery support intervention to promote OUD treatment retention tailored to PEH by incorporating qualitative findings from patient focus groups and national Health Care for the Homeless program key stakeholder interviews into a consensus building Delphi process, and (2) pilot test the feasibility, acceptability, and fidelity of the peer recovery support intervention to promote OUD treatment retention among PEH. The proposed research complements the National Institute on Drug Abuse’s (NIDA’s) 2022-2026 strategic plan by addressing two priority areas: advancing the science of recovery support and conducting research in real-world clinical settings. This proposal also supports several cross-cutting priorities at NIDA: promoting collaboration with community stakeholders, incorporating patient perspectives into intervention development, and reducing health disparities. The principal investigator’s (PI’s) long-term career goal is to become an independent physician- investigator with expertise in designing and testing interventions to improve the health and health care of marginalized individuals with substance use disorders. Though the PI has a strong research foundation in epidemiologic and health services research methods, she will need additional training in (1) community- engaged research with populations disadvantaged by social determinants of health, (2) mixed methods research, and (3) design and conduct of interventional clinical trials in real-world settings to successfully carry out this proposal and achieve her long-term goals. To accomplish these training objectives and her proposed research plan, the PI assembled an exceptional team of mentors, developed a comprehensive training plan, and will leverage the research expertise and infrastructure at Massachusetts General Hospital, the educational expertise of Harvard Medical School, and the clinical infrastructure and homelessness expertise of Boston Health Care for the Homeless Program. The successful completion of the proposed research will position the PI to submit an NIH R01 application to conduct a full-scale trial of a peer recovery support intervention to promote OUD treatment retention among PEH and facilitate her goal of becoming an independent investigator.