Overcoming barriers with an innovative support system for OUD treatment
Fishman and his colleagues “stole shamelessly from the playbook of successful behavioral interventions” as they developed the Youth Opioid Recovery Support model, he said. The intervention consists of four supports – assertive outreach, family involvement, medication home delivery, and incentives for medication compliance – designed to overcome these barriers to continuing medication treatment for OUD.
The study team uses assertive outreach to encourage participants to receive OUD medications as prescribed and engage participants and family members via text messaging, phone calls, Facebook Messenger, email, and postal mail. Research participants agree to involve a parent, another family member, or a significant other to help create a treatment plan and encourage the participant to continue his or her medication regimen. With home delivery, long-acting OUD medication can be given in a person’s home, work, a clinic, or elsewhere. Finally, study participants receive financial incentives in the form of gift cards when they receive a dose of OUD medication.
A pilot test of the model at Mountain Manor yielded impressive results. The research team randomly assigned 40 young adults to one of two groups. One group participated in the full intervention, and the control group received the clinic’s usual treatment for OUD (one dose of a long-acting OUD medication and referrals for continued treatment). After six months, 19 of the 20 (95 percent) participants in the control group had relapsed to regular opioid use, but only 11 of the 18 (60 percent) intervention participants had relapsed. In addition, participants in the intervention group had received an average of more than four monthly doses of medication during the study; participants in the control group received less than one dose on average.
Refining the model to get better results
The promising results of the pilot led to the current 2-year project funded by the NIH HEAL Initiative, which is testing various tweaks of the YORS model to see if they help young adults continue medication treatment.
“As successful as the combined intervention model was, more than half of the pilot-test participants still relapsed,” Fishman explained. “So, for the first one or two years of the HEAL project, we are refining and improving the YORS intervention based on lessons learned from the pilot.”
To get feedback and ideas for improving the model, the study team brought together focus groups of pilot-study participants and their family members, clinicians, and representatives of community advocacy groups. Some of the ideas are being tested in three cycles of mini-tests of modifications of the intervention.
For each cycle, eight young adults ages 18–26 seeking treatment for OUD at Mountain Manor participate in a refined version of the model for three months. The study team is tracking the number of medication doses participants receive, opioid relapse, days of opioid use, HIV risk behaviors, criminal behaviors, family member distress, and other measures.
The project’s first test-cycle variation is use of a mobile van for administering medications.
“The mobile van is well-suited to the current situation with the coronavirus pandemic,” Fishman said.
The pandemic is another barrier to treatment, because people are reluctant to go to clinics, and clinic staff worry about going into people’s homes due to the possible risk of exposure to the virus. The study team is modifying a van so that only the study participant and a nurse are involved in medication treatment. The van can be disinfected, and the air conditioning is kept running to ensure good circulation.
“Other tweaks we might test during the three cycles of the NIH HEAL Initiative project could include more frequent text messaging (even daily), video telehealth family sessions, more positive affirmations and good reports to families, transportation for study visits, and use of case management software,” Fishman said. “We will continue to ask for suggestions to improve.”
Once Fishman and his team have the results of the NIH HEAL Initiative project and have a better idea of what works, they’ll crystallize the refinements into a final system that they will test in a larger, 3-year randomized trial with 120 participants, to be funded by the National Institute on Drug Abuse. This approach — optimizing the combined model prior to a costly, time-consuming larger trial — reduces some of the risks involved in the larger trial that could provide solid evidence of the effectiveness of the YORS model.
The intervention has the potential to reduce barriers to treatment for young people who have OUD. Future research may focus on figuring out which components of the model are most meaningful and on tailoring treatment to meet individual needs.
If successful, the NIH HEAL Initiative project could set the stage for future work, including a cost analysis, a larger study at more sites for a longer time, and tests of less-intensive versions of the model. Such data could support wider use of the combined intervention approach, especially if healthcare costs associated with OUD are reduced by helping more people recover.
Read About This Project on NIH RePORT
Learn more about Fishman’s project, “The Youth Opioid Recovery Support (YORS) Intervention: An Assertive Community Treatment Model for Improving Medication Adherence in Young Adults with Opioid Use Disorder.”
Find More Projects in This Research Focus Area
Explore programs and funded projects within the Translation of Research to Practice for the Treatment of Opioid Addiction research focus area.
National Center for Complementary and Integrative Health (NCCIH)
Learn more about NCCIH’s role in the NIH HEAL Initiative.