Funded Projects

People who work in harm reduction settings aiming to keep people with substance use disorders safe from overdose and other negative health outcomes are exposed to high rates of lifetime and occupational stress and trauma. Their work conditions can have adverse effects on patient care and also on their own well-being, such as unmet mental health needs, burnout, and relapse. This project will adapt the Stress First Aid intervention for harm reduction workers. The research will test the impact of this intervention on social support, burnout, secondary traumatic stress, use of mental health care, engagement, and turnover. The long-term goal of this work is to implement a sustainable and effective national occupational stress intervention for harm reduction workers to strengthen their important role in helping individuals get treatment and avoid overdose.

Medications for opioid use disorder (OUD) are safe and effective. However, many people do not take them long enough to achieve sustained recovery, putting them at risk of overdose. Peer recovery support services—which are delivered by trained individuals with lived experience of addiction and recovery—may help people with OUD initiate and stay in medication treatment. This project will adapt peer recovery support services for use in outpatient substance use treatment settings and test their implementation and effectiveness in helping people with OUD achieve long-term recovery. If successful, the program could be implemented in a variety of outpatient treatment programs, including in underserved rural areas.

Computerized clinical decision support tools offer a promising strategy to standardize and scale evidence-based practices to keep pace with the dynamic nature of the opioid crisis and overcome barriers to substance use disorder treatment. To change practice, such tools must be useful, usable, able to be integrated into routine care delivery, and supported by a multicomponent implementation strategy. This project will refine and evaluate the uptake, usability, and equity of a nationally disseminated multicomponent clinical decision support intervention to increase initiation of medication treatment for opioid use disorder in the emergency department.

People who inject drugs often have posttraumatic stress disorder (PTSD). Co-occurring PTSD puts these individuals at increased risk of illicit opioid use, opioid use disorder, overdose, HIV, and hepatitis C virus infection. This project will adapt, with input from the community, an evidence-based PTSD treatment program for people with both opioid use disorder and PTSD who are participating in a syringe service program. The treatment will then be tested in multiple syringe service programs to determine its potential for improving outcomes for these individuals who are often marginalized in traditional care.

Current practices and culture in treatment programs for opioid use disorder, including treatment with methadone, may contribute to treatment interruption and relapse risk. This project will develop and test a staff-level intervention for opioid treatment programs to increase methadone treatment retention and decrease in-treatment overdose and patient- and staff-reported posttraumatic stress symptoms. The intervention includes components to address trauma in patients and staff as well as separate supervisory structures for counselors/case managers and medical providers.

Women with opioid use disorder (OUD) are disproportionately impacted by physical, sexual, and psychological intimate partner violence and posttraumatic stress disorder (PTSD). Yet, treatment approaches that address all these conditions together in OUD treatment settings are lacking. To address this gap, this project will evaluate delivery of two evidence-based interventions to address PTSD (Present-Centered Therapy+ and Helping to Overcome PTSD through Empowerment) for women seeking OUD treatment who have experienced intimate partner violence. It will also determine if integrated treatment can help retain the women in medication treatment for OUD.

Many people in jail have both opioid use disorder (OUD) and posttraumatic stress disorder (PTSD). Among people with OUD released from jail, only few engage in treatment and medication therapy once they are back in the community, and opioid overdose is a leading cause of death in this population. This project will test whether identifying and initiating treatment of PTSD in people receiving OUD treatment in jail can increase these individuals’ likelihood of starting and staying in medication treatment after release and thus reduce overdose risk.

People who survive sexual violence are at increased risk for posttraumatic stress disorder (PTSD) and opioid misuse. Emergency departments are often the first, and in some cases only, contact with the medical care system for survivors of sexual violence. This makes them a suitable setting to initiate interventions to address the risk of PTSD and opioid misuse in these individuals. This project will develop and test a brief, low-cost video and text message intervention that can be initiated in the emergency department to prevent onset or escalation of PTSD and opioid misuse among people who survive sexual violence.

Despite substantial increases in overdose deaths among people who use methamphetamine, little is known about how to effectively provide harm reduction services to these individuals. This project will combine and test two harm reduction interventions for people who use methamphetamine. First, peer recovery support specialists will help identify personal harm reduction goals. The project will also test the value of incentives toward achieving these goals (a strategy known as contingency management).

Harm reduction supplies include fentanyl test strips that allow people who use drugs to identify whether the substance(s) they plan to take contain fentanyl and sterile syringes that help to prevent the spread of infectious diseases among people who inject drugs. One potential way to increase access to harm reduction supplies is mail delivery. This project will describe state-level policies that deter the use of mail-based delivery of harm reduction services, examine characteristics of people who use mail-based harm reduction services, and assess individual preferences related to mail-based harm reduction services.

Numerous harm reduction strategies are available to reduce the harmful consequences of drug use. Examples include syringe services programs that provide sterile syringes, easy access to naloxone, and fentanyl test strips that may help people identify whether the substance(s) they plan to take contain fentanyl. This project aims to evaluate the use and effectiveness of several strategies in an urban environment as well as determine the openness and commitment of providers to offering them. 

There has been a substantial increase in overdose deaths among Black and Hispanic/Latino people who use drugs. This project will test and evaluate delivery of harm reduction services from a mobile van. A community-based care coordinator will assess the specific needs of each participant (such as housing, food assistance, and mental health treatment) toward the goal of linking each person to appropriate services.

Access to harm reduction services are often limited in rural areas. Secondary distribution is a potentially promising strategy for rural areas that involves people sharing harm reduction supplies such as naloxone or fentanyl test strips with other people who use drugs that do not come into contact with harm reduction service providers. This project aims to examine drug use and use of harm reduction services among people in rural communities, as well as highlight factors that make people more or less likely to use secondary distribution approaches.