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Principal Investigator: CRYSTAL FULLER LEWIS
Organization: FRIENDS RESEARCH INSTITUTE, INC.
Fiscal Year: 2024
Award: $225,981
Funding agency: National Institute on Drug Abuse
PROJECT SUMMARY
Black and Latinx people who use opioids (PWUO) bear a disproportionate burden of opioid-related overdose
deaths. Racial disparities among PWUO are exacerbated by persistent socioeconomic and structural barriers
(e.g., stigma, lack of social support, housing instability) which may be partially addressed using scalable open-
source solutions (e.g., peer recovery coaches, mobile health, telemedicine). With NIH support, we have
validated a theory-based, AI-driven texting using natural language processing in a publicly-funded health system
to provide real-time responses to patient queries combined with automated texts to enhance identification and
address participant unmet SDH needs (e.g., access to peer support, healthcare), and linkages and retention in
buprenorphine treatment per the medical management model (e.g., patient education, self-management). We
have also refined an evidence-supported Cultural Structural Humility (CSH) training for peer recovery coaches
(PRCs) that goes beyond a social determinants of health (SDH) framework to also include stigma reduction,
health habitus, and patient navigation to improve clinical outcomes and social services use among PWUO. This
proposal aims to adapt the evidence-supported CSH training to interactive video modules for peer recovery
coaches (PRCs), and refine an artificial intelligence (AI)-driven texting tool to reinforce core CSH principles. The
3-month pilot RCT will test AI-driven CSH-enhanced texting tool + CSH-trained PRC providing telephone-based
services coordination (multimodal intervention arm-1) vs. AI-driven CSH-enhanced texting tool (intervention
arm-2) vs. treatment as usual / informational pamphlets only (control arm) among emergency department-
enrolled Black / Latinx PWUO (N=150) to estimate rates of PRC-PWUO contact, AI-driven texting use among
PWUO, assess potential for pre-/post-intervention impact on reduction of felt and/or anticipated stigma, clinical
outcomes (i.e., time to initial receipt of buprenorphine), and social services use at 1- and 3-months to obtain
intervention effect sizes, and estimate the associated cost of implementing and sustaining the multimodal
intervention (e.g., cost-per OUD treatment days). The RE-AIM framework will inform implementation of this
multimodal intervention that has high public health impact on complementing the HHS Overdose Prevention
Strategy (i.e., harm reduction, OUD treatment, and recovery support) in a manner that is scalable, sustainable,
and equitable using open-source solutions. Our team is uniquely positioned to obtain data that will inform a
subsequent large-scale efficacy trial evaluating our proposed multimodal intervention to increase access to
buprenorphine and social services among Black / Latinx PWUO.
Terms: <AI system><Accident and Emergency department><Address><Administrator><Artificial Intelligence><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><Booklets><Brochures><Buprenorphine><Clinical><Code><Coding System><Computer Reasoning><Data><Emergency Department><Emergency room><Enrollment><Equity><Feedback><Funding><Harm Minimization><Harm Reduction><Health><Health system><Healthcare><Hospitals><Housing><Information Services><Institutional Racism><Intervention Studies><Latine><Latinx><Latinx group><Latinx individual><Latinx people><Latinx population><Libraries><Machine Intelligence><Measures><Medical><Mental Health><Mental Hygiene><Methods><Modeling><Motivation><NIDA><NIH><National Institute of Drug Abuse><National Institute on Drug Abuse><National Institutes of Health><Natural Language Processing><Opiate user><Opioid drug user><Outcome><PWUO><Pamphlets><Participant><Patient Education><Patient Instruction><Patient Training><Patients><Position><Positioning Attribute><Preventative strategy><Prevention strategy><Preventive strategy><Provider><Psychological Health><Public Health><QOL><Quality of life><RE-AIM><Randomized><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Reaction Time><Recovery Support><Research><Response RT><Response Time><SAMHSA><Self Management><Service delivery model><Service model><Services><Social Service><Social Work><Social support><Structure><Substance Abuse and Mental Health Services Administration><Survey Instrument><Surveys><Systematic Racism><Systemic Racism><Technology><Telemedicine><Testing><Text Messaging><Time><Training><Treatment Period><United States National Institutes of Health><United States Substance Abuse and Mental Health Services Administration><Work><access disparities><accessibility disparities><arm><automated text message><automated texting><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><buprenorphine treatment><care as usual><care coordination><care delivery model><community partnership><coordinating care><cost><develop therapy><disparities in access><disparities in race><disparity due to race><efficacy trial><enroll><experience><health care><health care delivery model><healthcare delivery model><housing instability><improved><inequality due to race><inequality in access><inequity due to race><inequity in access><inequity in accessibility><innovate><innovation><innovative><instably housed><intervention arm><intervention development><intervention effect><intervention research><interventional research><interventional study><interventions research><m-Health><mHealth><medical college><medical schools><medication for opioid use disorder><mobile health><multi-component intervention><multi-faceted intervention><multi-modal intervention><multi-modality><multicomponent intervention><multifaceted intervention><multimodal intervention><multimodality><natural language understanding><obstacle to care><obstacle to healthcare><open source><opiate deaths><opiate mortality><opiate overdose><opiate related overdose><opioid deaths><opioid drug overdose><opioid induced overdose><opioid intoxication><opioid medication overdose><opioid mortality><opioid overdose><opioid overdose death><opioid poisoning><opioid related death><opioid related overdose><opioid toxicity><opioid user><overdose death><overdose fatalities><overdose prevention><patient navigation><peer recovery><peer support><people who use opioids><persons who use opioids><post intervention><psychomotor reaction time><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial disparity><racial inequality><racial inequity><racially unequal><randomisation><randomization><randomly assigned><reach, efficacy, adoption, implementation, and maintenance><recruit><response><scale up><school of medicine><service coordination><short message service><skills><social health determinants><social stigma><social support network><socio-economic><socio-economically><socioeconomically><socioeconomics><stigma><telephone based><texting><theories><therapy development><tool><treatment arm><treatment as usual><treatment days><treatment development><treatment duration><unstable housing><unstably housed><usability><user centered design><usual care><video module>