A Randomized Clinical Trial of a Peer Education Intervention to Promote Social Diffusion of Overdose Prevention and Drug Use Cessation in High Burden Communities

About This Grant

Abstract: The US opioid epidemic has significantly impacted public health, with high levels of opiate dependence and a surge in overdoses. The increasing prevalence of fentanyl and xylazine in the drug supply underscores the importance of novel approaches. Additionally, times of withdrawal have been found to increase overdose risk behaviors, highlighting a need to target this period. Particularly in the context of xylazine, as naloxone does not reverse the effect of xylazine-induced respiratory depression, enrollment and retention in medications for opioid use disorder (MOUD) is vital to reduce drug overdoses. In our prior work, we have shown that PWUO can be trained as peer educators (PEs) for overdose prevention, but we have not integrated withdrawal management or a social network approach to MOUD engagement. This five year proposal seeks to develop, implement, and rigorously evaluate a novel PE intervention designed to prevent overdoses and promote MOUD and drug use cessation among a population of PWUO disproportionally impacted by overdose (Funding Option B). The intervention has three novel components: (a) social network diffusion of overdose prevention and MOUD promotion, (b) strategies to address high-risk withdrawal periods, and (c) Certified Peer Recovery Specialist (CPRS)/ Contingency Management (CM) for MOUD engagement. Using an RCT study design, 300 index PWUO will be recruited along with 300 of their network members who use opioids. The indexes will be randomly assigned to the (1) standard of care (SOC) or (2) an experimental peer education condition (PEC). The proposed design allows for the examination of the effectiveness of the intervention on indexes and diffusion of behavior change to network members. The RE-AIM framework will guide the collection of qualitative interview data to identify barriers and facilitators to intervention implementation. Assessments will occur every 3 months for one year. 1. Development and Pilot Testing: Design and pilot test intervention components that diffuse overdose prevention behaviors and MOUD within social networks, promote overdose prevention during withdrawal, and enhance MOUD engagement through CPRS/CM. 2. Implementation of RCT: Evaluate the intervention in a 1:1 RCT, testing an intervention that includes (a) social network diffusion of overdose prevention and MOUD promotion, (b) strategies to address high-risk withdrawal periods, and (c) CPRS/CM for MOUD engagement (N=600; 300 index participants, 300 network members). 3. Evaluation of Outcomes: Assess changes in nonfatal overdose, drug use cessation, MOUD engagement, and overdose prevention behaviors among index participants, as well as the diffusion of these behaviors to their social network members.