Community Driven Substance Use Recovery for High Opioid Overdose Areas

In 2023, 105,007 people died from drug overdoses in the US, with mortality rates particularly high in geographic areas with higher overdose rates, primarily due to fentanyl in the drug supply. Despite national media focus on opioid-involved deaths, more attention needs to be given to morbidity and mortality related to opioid use disorder (OUD) and alcohol use disorder (AUD) in these high overdose areas. These communities face a disproportionate burden of illness compounded by limited access to medication for addiction treatment (MAT), inadequate technology, a shortage of addiction providers, and insufficient harm reduction services.
Deaths involving alcohol and opioids continue to worsen, making the study of treatment interventions more urgent. Addressing healthcare gaps in these areas is essential for implementing effective interventions tailored to the needs of all populations. To confront the challenges of decreased treatment initiation, engagement, and adherence to addiction treatment, the Imani (meaning Faith in Swahili) Breakthrough program was developed in 2017 through a community-based participatory research (CBPR) process. This faith-based, person-centered harm reduction recovery program, delivered in churches and administered by trained representatives with lived SUD experience, focuses on the 8 dimensions of wellness, 7 domains of community citizenship, education, and referral to MAT. The Imani Breakthrough provides education, mutual support, and intensive wraparound coaching in a safe and familiar environment. Preliminary evidence shows Imani is highly relevant and accessible, having reached over 1000 people in Connecticut.
The main goal of this study is to optimize methods for increasing access to, uptake of, and engagement in MAT among high overdose communities. Through a multilevel CBPR initiative and a rigorous RCT, we will evaluate the impact of a church-based telehealth MAT option (Imani + CTM) compared to traditional MAT Referral and Linkage (Imani + MAT R&L). Our specific aims include:
Evaluating the impact of Imani + CTM on medication for addiction treatment initiation and engagement compared to Imani + MAT R&L.
Assessing changes in substance use over time for Imani + CTM compared to Imani + MAT R&L.
Evaluating potential mediators and moderators (e.g., choice, SDOH) of improvements in primary SUD outcomes.
Exploring differences in the 7 domains of community citizenship and 8 dimensions of wellness between those enrolled in a MAT condition and those not enrolled.
This research aims to provide a promising intervention to reduce deaths by increasing SUD treatment initiation, engagement, and enhancing individuals' capacity to live fuller lives in their communities.

Grant Number: 5U01DA060441-04
NIH Institute/Center: NIH
Principal Investigator: Chyrell Bellamy