Literature Collection
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Opioids & SU
The Literature Collection contains over 11,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
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BACKGROUND: Opioid overdose deaths involving synthetic opioids, particularly illicitly manufactured fentanyl, remain a substantial public health concern in North America. Responses to overdose events (e.g., administration of naloxone and rescue breathing) are effective at reducing mortality; however, more interventions are needed to prevent overdoses involving illicitly manufactured fentanyl. This study protocol aims to evaluate the effectiveness of a behavior change intervention that incorporates individual counseling, practical training in fentanyl test strip use, and distribution of fentanyl test strips for take-home use among people who use drugs. METHODS: Residents of Rhode Island aged 18-65 years who report recent substance use (including prescription pills obtained from the street; heroin, powder cocaine, crack cocaine, methamphetamine; or any drug by injection) (n = 500) will be recruited through advertisements and targeted street-based outreach into a two-arm randomized clinical trial with 12 months of post-randomization follow-up. Eligible participants will be randomized (1:1) to receive either the RAPIDS intervention (i.e., fentanyl-specific overdose education, behavior change motivational interviewing (MI) sessions focused on using fentanyl test strips to reduce overdose risk, fentanyl test strip training, and distribution of fentanyl test strips for personal use) or standard overdose education as control. Participants will attend MI booster sessions (intervention) or attention-matched control sessions at 1, 2, and 3 months post-randomization. All participants will be offered naloxone at enrolment. The primary outcome is a composite measure of self-reported overdose in the previous month at 6- and/or 12-month follow-up visit. Secondary outcome measures include administratively linked data regarding fatal (post-mortem investigation) and non-fatal (hospitalization or emergency medical service utilization) overdoses. DISCUSSION: If the RAPIDS intervention is found to be effective, its brief MI and fentanyl test strip training components could be easily incorporated into existing community-based overdose prevention programming to help reduce the rates of fentanyl-related opioid overdose. TRIAL REGISTRATION: ClinicalTrials.gov NCT04372238 . Registered on 01 May 2020.
BACKGROUND: The purpose of this study was to report on feasibility, acceptability, and initial efficacy data cognitive-behavioral therapy for perceived isolation (CBT-PSI) compared to health education among individuals with opioid use disorders (OUD) reporting elevated loneliness. METHODS: Participants (n = 125) with OUD reporting elevated loneliness were recruited using online advertising to participate in a telehealth-delivered randomized clinical trial. Participants received either a 6-session CBT-PSI (n = 63) or health education (n = 62). Measures assessing loneliness, quantity of social interactions, perceived social support, substance use, substance use consequences, and treatment engagement among others, were completed at baseline, post-intervention, and 1- and 2-months post-intervention. Participants also reported on treatment acceptability for both conditions. RESULTS: Target enrollment was met with loneliness, social disconnectedness measures, and substance use reflecting a clinically severe sample. Retention was high (> 80%) for both conditions. Participants rated both Health Education and CBT-PSI as acceptable, helpful, and useful interventions to address loneliness and opioid use. Loneliness was reduced and quantity of social interactions and perceived social support were increased to the same extent for both conditions and across the follow-up assessments. Opioid use and overall substance use were reduced in both conditions; however, the reductions among participants received CBT-PSI were significantly greater compared to Health Education. CONCLUSIONS: This study supports the feasibility and acceptability of CBT-PSI. CBT-PSI findings related to loneliness, substance use, and other social connectedness outcomes are encouraging. Additional testing of CBT-PSI in a fully-powered trial is warranted.