Peer Recovery Support for Opioid Use Disorder Treatment Retention
Reducing OUD Treatment Dropout: Development and Pilot Test of a Peer Recovery Support Intervention in Primary Care
The goal of this clinical trial is to learn whether adding peer recovery support services to standard opioid use disorder (OUD) treatment in primary care helps patients stay in treatment longer. The main question it seeks to answer is whether it is feasible to deliver a peer recovery support intervention alongside medication-assisted treatment (buprenorphine) in a Philadelphia primary care clinic.
Participants will receive standard OUD treatment (buprenorphine) combined with peer recovery support services for 180 days. They will attend study visits at baseline, weekly for the first 2 weeks, then every 2 weeks, then monthly, and complete assessments about substance use, medication adherence, self-efficacy, resilience, and coping. Participants will also take part in brief periodic interviews about their experience with peer support.
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Descripción detallada
Opioid use disorder (OUD) is a chronic, relapsing condition associated with substantial morbidity, mortality, and social burden. Buprenorphine, delivered in primary care settings, is an evidence-based treatment for OUD, yet treatment dropout remains a critical barrier to recovery. Many patients disengage during the early weeks following induction, before buprenorphine has had the opportunity to stabilize their condition. Peer recovery support (PRS) services, provided by individuals with lived experience of addiction and recovery, represent a promising strategy to improve retention, but the evidence base for optimized peer interventions in primary care OUD treatment remains limited.
The peer intervention evaluated in this study was developed through a systematic optimization process conducted in partnership with OUD, peer, and implementation experts, with extensive input from patients, practitioners, and community stakeholders. Intervention design drew on surveys and qualitative studies of Philadelphia-region OUD treatment programs with existing peer support services, as well as best practices from community health worker models in other chronic disease settings. Component elements, including peer qualifications, supervision structure, training curriculum, caseload size, scope of services, and care team integration, were systematically evaluated and refined prior to the pilot.
The resulting intervention is organized around five core structural elements: (1) clinically integrated supervision with structured case review; (2) standardized recruitment and hiring practices emphasizing empathy, problem-solving capacity, and community engagement; (3) a competency-based training curriculum covering psychosocial support, crisis response, stigma, interprofessional ethics, social determinants of health, and system navigation; (4) stage-tailored peer-patient contact, with intensive engagement during the high-dropout early induction period transitioning to stabilization-focused support as treatment progresses; and (5) active peer wellness practices to mitigate compassion fatigue and burnout.
This pilot study will evaluate the feasibility, acceptability, and operational implementation of the intervention within primary care-based buprenorphine treatment programs and generate data to inform a future randomized controlled trial.
Tipo de estudio
Inscripción (Estimado)
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, Estados Unidos, 19104
- Penn Family Medicine
-
-
Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
- Adulto
- Adulto Mayor
Acepta Voluntarios Saludables
Descripción
Inclusion Criteria:
- Age 18 years or older
- Diagnosis of opioid use disorder (OUD)
- Currently receiving or initiating buprenorphine treatment from a primary care physician
- Able to communicate in English
- Access to a phone
- Able and willing to provide written informed consent
Exclusion Criteria:
- Acute suicidal ideation or intent
- Active mania or psychotic episode
- Significant cognitive impairment
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Cuidados de apoyo
- Asignación: N / A
- Modelo Intervencionista: Asignación de un solo grupo
- Enmascaramiento: Ninguno (etiqueta abierta)
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
|
Experimental: Peer Support
|
Peer recovery support services delivered by trained, certified peers with lived experience of opioid use disorder, added to standard medication-assisted treatment (buprenorphine) in a primary care setting.
Peer services are structured around three stages of OUD treatment (initial engagement, early treatment, and stable treatment) with contact intensity tailored to dropout risk at each stage (approximately 2 contact hours/week during initial engagement).
Contact modalities include in-office meetings, phone calls, texts, and appointment reminders.
Peers are supervised and integrated as full members of the clinical care team.
The intervention was developed with input from OUD, peer, and implementation experts and informed by qualitative and survey data from Philadelphia-region OUD treatment programs.
Caseload: approximately 15 patients per peer.
Duration: 180 days.
|
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
OUD treatment retention
Periodo de tiempo: 180 days
|
Retention in OUD treatment measured as time in days from treatment initiation (buprenorphine induction) to dropout (unplanned treatment termination) or treatment completion over the 180-day study period.
|
180 days
|
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Self-report opioid use
Periodo de tiempo: 180 days
|
Assessed using an abbreviated 30-day Time-Line Follow-Back (TLFB) instrument capturing self-reported opioid use at each study visit.
|
180 days
|
|
Buprenorphine adherence
Periodo de tiempo: 180 days
|
Assessed using the Brief Medication Questionnaire (self-report).
|
180 days
|
|
Resilience, coping, and self-efficacy
Periodo de tiempo: 180 days
|
A 30-item composite questionnaire combining three patient-centered outcome domains to minimize participant burden.
Section 1 (Resilience, 10 items) uses a 5-point Likert scale rating the past month, with 4 items reverse-scored; scores range from 10 to 50, with higher scores indicating greater resilience.
Section 2 (Coping Strategies, 10 items adapted from the Brief COPE) uses a 4-point scale rating frequency of coping strategy use, including a substance use item; scores range from 10 to 40, with higher scores indicating greater frequency of coping strategy use.
Section 3 (Abstinence Self-Efficacy, 10 items adapted from the Alcohol Abstinence Self-Efficacy Scale) uses a 5-point confidence scale assessing ability to remain opioid-free across situational triggers over the past week; scores range from 10 to 50, with higher scores indicating greater confidence in maintaining opioid abstinence.
|
180 days
|
|
Opioid urine drug screen positivity
Periodo de tiempo: 180 days
|
Proportion of urine drug screens positive for opioids, obtained at routine clinical visits throughout the study period.
|
180 days
|
Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Rebecca A Harris, MD, University of Pennsylvania
Publicaciones y enlaces útiles
Publicaciones Generales
- Bao Y, Zhang H, Hutchings K, Harris RA, Calderbank T, Schackman BR. Medicaid-Covered Peer Support Services Used by Enrollees With Opioid Use Disorder. JAMA Netw Open. 2024 Jul 1;7(7):e2420737. doi: 10.1001/jamanetworkopen.2024.20737.
- Harris RA, Campbell K, Calderbank T, Dooley P, Aspero H, Maginnis J, O'Donnell N, Coviello D, French R, Bao Y, Mandell DS, Bogner HR, Lowenstein M. Integrating peer support services into primary care-based OUD treatment: Lessons from the Penn integrated model. Healthc (Amst). 2022 Sep;10(3):100641. doi: 10.1016/j.hjdsi.2022.100641. Epub 2022 Jul 2.
- Harris RA, Mandell DS, Kampman KM, Bao Y, Campbell K, Cidav Z, Coviello DM, French R, Livesey C, Lowenstein M, Lynch KG, McKay JR, Oslin DW, Wolk CB, Bogner HR. Collaborative care in the treatment of opioid use disorder and mental health conditions in primary care: A clinical study protocol. Contemp Clin Trials. 2021 Apr;103:106325. doi: 10.1016/j.cct.2021.106325. Epub 2021 Feb 22.
- Harris RA, Kearney M, Keddem S, Calderbank T, Tomczuk L, Clapp J, Perrone J, Kranzler HR, Long JA, Mandell DS. Organization of primary care and early MOUD discontinuation. Addict Sci Clin Pract. 2024 Dec 19;19(1):96. doi: 10.1186/s13722-024-00527-w.
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Actual)
Finalización primaria (Estimado)
Finalización del estudio (Estimado)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- 858768
- K23DA054157 (Subvención/contrato del NIH de EE. UU.)
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Descripción del plan IPD
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .
Ensayos clínicos sobre Trastorno por uso de opioides
-
Nanfang Hospital of Southern Medical UniversityShenzhen People's Hospital; Second Affiliated Hospital of Guangzhou Medical UniversityAún no reclutandoLesiones Pancreáticas Sólidas | USE-FNB
-
Asan Medical CenterDesconocidoUSE-PAAF | CitodiagnósticoCorea, república de
-
University of California, DavisAún no reclutandoBiopsia | Biopsia guiada por USE | Diagnóstico de un trastorno pancreatobiliarEstados Unidos
-
Cairo UniversityAún no reclutandoProtector bucal use lesiones orofaciales prevención de protección bucal impresaEgipto
-
University of TehranReclutamientoPancreatitis Aguda | Biopsia guiada por USEIrán
-
Assiut UniversityAún no reclutandoTomografía computarizada | Biopsia guiada por USE | Lesiones Pancreáticas Localizadas en el Cuerpo o la Cola
-
Milton S. Hershey Medical CenterNational Cancer Institute (NCI)TerminadoQuiste pancreático | USE-PAAFEstados Unidos
-
Sixth Affiliated Hospital, Sun Yat-sen UniversityTerminadoCáncer de recto | USE-PAAF | Remisión Patológica CompletaPorcelana
-
National Cheng-Kung University HospitalDesconocidoMétodo de succión húmeda basado en heparina en EUS Biopsia con aguja fina de masa pancreática sólidaNeoplasias pancreáticas | Ultrasonografía endoscópica | USE-PAAFTaiwán
Ensayos clínicos sobre Peer Support
-
Potomac Health FoundationsNational Institutes of Health (NIH); National Institute of Drug AbuseActivo, no reclutandoTrastorno por uso de sustancias | Trastorno por uso de opioidesEstados Unidos
-
MYnd AnalyticsUniversity of Ottawa; Canadian Forces Health Services Centre OttawaDesconocidoDepresión | Diagnóstico no psicótico como comorbilidadCanadá
-
MYnd AnalyticsSuspendido
-
Medical University of South CarolinaNational Institutes of Health (NIH)ReclutamientoEnfermedad pulmonar intersticial | Fibrosis Pulmonar ProgresivaEstados Unidos
-
University of California, Los AngelesTerminado
-
Icahn School of Medicine at Mount SinaiAmerican Heart AssociationTerminadoAterosclerosis | Intervención de estilo de vida | Promoción de la salud cardiovascular en adultosEstados Unidos
-
Monash University MalaysiaMinistry of Higher Education, MalaysiaTerminadoPrevención primaria de enfermedades cardiovascularesMalasia
-
University of GiessenKruse Johannes; Florian Blachutzik; Andreas RiethAún no reclutandoInsuficiencia cardiaca | Adherencia, Medicación | Adherencia, Tratamiento
-
University of California, Los AngelesNational Institute on Drug Abuse (NIDA); University of California, Berkeley; Charles... y otros colaboradoresReclutamientoPrevención del VIH | Virus de la hepatitis C (VHC) | Infecciones de transmisión sexual (ITS) | Encarcelamiento | Trastorno por uso de sustancias (TUS) | Profilaxis previa a la exposición (PrEP)Estados Unidos
-
Amager HospitalThe Peer partnership associationTerminadoTrastorno de salud mental | Deterioro de la salud mental | Grupo de pares | Problemas PsicosocialesDinamarca