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Chronic low back pain is a leading cause of disability and reduced quality of life for nearly 100 million individuals in the United States. Approximately 5 to 10 percent of these individuals are prescribed opioids for treating their chronic low back pain. Limited data exists on the long-term efficacy of opioid treatment while much concern exists regarding the harm they can do to a person. Despite medication treatment patients still suffer from inadequate pain relief, impaired function, and quality of life.

This study sought to compare the long-term effectiveness of two types of alternative therapy approaches - mindfulness based therapy (MBT) and cognitive behavioral therapy (CBT) - for treating chronic low back pain especially those being treated by opioids.

MOUD remains an underutilized evidence-based practice with potential to reduce opioid use disorder (OUD) and save lives. Washington State expanded its Hub & Spoke (H&S) model for OUD medication treatment (MOUD: buprenorphine, methadone, naltrexone) by funding additional networks and developing a low-barrier, Opioid Treatment Network (OTN) model. The Washington H&S model was designed as a flexible approach incorporating primary care and substance use treatment programs, referral organizations, nurse care managers and care navigators. The OTN model offers MOUD induction in non-traditional settings (e.g., emergency departments, jails) with connections to community partners who will offer MOUD maintenance.

This study examined the implementation and effectiveness of the H&S and OTN models for increasing MOUD treatment and improving outcomes for people with OUD. Washington's H&S and OTN interventions were funded through federal STR/SOR opioid response grants, and the expanded H&S networks were funded through the state. The study, Hub and Spoke Opioid Treatment Networks: 2nd Generation Approaches to Improve Medication Treatment for Opioid Use Disorders (R01DA0561067), and its supplement (R01DA0561067S1) was part of NIH's HEAL initiative, and built on an earlier study (R33DA045851). All three studies were supported by the National Institute on Drug Abuse.

Expanding Access to Low-Barrier Opioid Use Disorder Treatment in Non-Traditional Settings: Washington's Opioid Treatment Network

• Increasing utilization of medications that treat opioid use disorders (MOUD) remains an essential strategy to curb the opioid crisis nationwide, especially among rural areas where access can present challenges. Washington State expanded access to MOUD through its opioid treatment networks (OTN), which provide low-barrier access to MOUD in non-traditional settings with an emphasis on buprenorphine and rural locations. The study examined changes in buprenorphine utilization between Medicaid beneficiaries who initiated treatment at OTNs compared to individuals outside OTN facilities and by rural-urban residence.

Differential Changes in Use of Medications for Opioid Use Disorder by Race-Ethnicity: Effects of a Hub-and-Spoke Model

• This study assessed whether delivery of opioid use disorder (OUD) treatment through a hub and spoke (HS) model is associated with better adherence to psychotropic medication treatment, compared to usual treatment. Washington State's HS model required each network to include at least one mental health program, so it was hypothesized that it would improve psychotropic medication adherence for people with both a mental health disorder (MHD) and an OUD.

Treatment for Comorbid Mental Health Disorders Among Patients Treated for Opioid Disorder: The Role of a Hub and Spoke Intervention

• The research team examined, separately for different racial-ethnic groups, whether use of medications for opioid use disorder (MOUD) increased more among people treated in a hub-and-spoke care model than among people treated in a non-hub-and-spoke model.

INtegrated Services for Pain: Interventions to Reduce Pain Effectively (INSPIRE) was a pragmatic randomized trial conducted from 2019 to 2023 with adults receiving chronic opioid therapy (COT) of at least 20 morphine milligram equivalents (MME) daily for chronic noncancer pain (CNCP). Participants were recruited from primary care and specialty pain clinics at three academic health centers in North Carolina and Tennessee. The study compared the effectiveness of the two behavioral interventions, 1) shared decision making (SDM) versus 2) motivational interviewing plus cognitive behavioral therapy for chronic pain (MI+CBT), on change in opioid dose, physical function, and pain interference. INSPIRE combined data from electronic health records (EHR) on opioid dose from baseline to 18 months and comorbidities with participant survey data at baseline, 6, and 12 months on the following topics:

• physical function,
• pain interference,
• pain intensity,
• anxiety,
• depression,
• pain severity,
• discontinuation of opioids,
• intent to reduce opioids,
• opioid use relative to baseline,
• adverse events,
• demographics,
• health insurance coverage,
• health literacy,
• patient-centered communication, and
• types of pain treatment used.

The collection includes three analysis datasets:

1. Adverse Events Dataset - one record per subject per adverse event
2. Opioid Prescriptions Dataset (post-processed opioid prescriptions used to derive the study's primary outcome) - one record per subject per opioid prescription
3. Outcomes Dataset (contains all of the study's demographics, primary, secondary, exploratory, and subgroup analysis variables) - one record per subject per timepoint

With the third highest rates of overdose fatalities in the state and complexities with providing treatment in a rural setting, Franklin County Sheriff's Office (FCSO) in Massachusetts made a strategic decision in 2011 to shift their jail facility away from simply operating as a place to contain people, to becoming a jail that played an important role in the treatment solution to the opioid use epidemic. After more than 10 years of this transformation, FCSO has been able to offer all three federally approved Medications for Opioid Use Disorders (MOUD) (i.e., buprenorphine, methadone, and naltrexone), provide high quality individual and group counseling, and facilitate a continuum of treatment care upon reentry. In 2020, at the height of the COVID-19 pandemic, FCSO capitalized on its previously built infrastructure and system partners to continue to offer its services. FCSO also continued offering individual and group counseling via telehealth throughout the pandemic and shifted to a mix of telehealth and in-person services in 2022.

From 2020 to 2023, the research team partnered with FCSO to study how their jail approached MOUD treatment, particularly via telehealth during the COVID-19 pandemic. The mixed-methods study aimed to understand whether treatment and individual counseling as its critical component could be done remotely, what facilitated or hindered its successful application, and how clients (i.e., incarcerated people) and the professionals supporting them perceived the effects.

This study includes 19 interview transcripts. The overall intent of the interviews was to gather information that could be used to develop and improve a single reporting website for overdose tracking and naloxone distribution metrics that would generate monthly reports to the State of Texas. The goal of this study was to develop and implement a digital ecosystem to improve opioid overdose reporting, tracking, and prevention across Texas. The study also aimed to understand the relationship between substance use behavior, stress response, and social support structures during the COVID-19 pandemic.

This study used in-depth, semi-structured individual telephone interviews with people in recovery from opioid use disorder (OUD) who had used medications for opioid use disorder (MOUD). Questions explored their narrative history of recovery, barriers and facilitators to accessing MOUD, perceptions of MOUD efficacy, the relationship between MOUD and 12-step support groups, treatment in the criminal justice system, and development of an ideal treatment facility. Individuals were recruited using a snowball sampling method involving three syringe service programs between 2018 and 2020.

Adoption of Innovations in Private Alcohol and Drug Treatment Centers is a multi-wave longitudinal study conducted between 2009 and 2013. The study goal was to measure the adoption and implementation of evidence-based treatment practices in treatment centers that received more than 50 percent of their total operational funding from sources that were not guaranteed from year to year. This definition is based on the concept of entrepreneurship, namely the necessity for the treatment organization to respond to changing conditions in the external political and economic environment in order to obtain half or more of its funding. The innovations considered are of three types usually specific to organizations treating substance use disorders:

• medication-assisted treatments
• psychosocial treatments
• managerial practices

This data set consists of one of the multiple "waves" of data collection. The data was collected at four points in time. The baseline data, collected from June 2009 through October 2011 from 327 treatment centers, were obtained through face-to-face onsite interviews ranging from 1 to 4 hours in duration. These interviews were conducted with administrators of the respective treatment centers. In 70 of the 327 treatment centers, an administrator of the overall center and the administrator of clinical operations separately completed administrative and clinical interviews. In the remaining 257 centers, all of the administrative and clinical data were collected from the administrator of the overall center since there was no specialized administrator of clinical operations. The baseline data available here merge the data collected through these two different procedures so that the variables measured are identical for all centers regardless of the procedure.

The collected data include detailed information on Medication Assisted Treatment (MAT) and other treatment strategies used by the center to treat opioid use disorder (OUD) and alcohol use disorder (AUD). In cases where medications were not used by a center questions were asked for reasons why available medications were not used in treatment. Other sections of the interviews covered data on the organizations, their management, and other clinical practices implemented for OUD, AUD, and substance use disorder (SUD).

Three follow-up interviews were conducted via telephone at six month intervals following the previous interview. These follow-up interviews were much shorter compared to the baseline interview. The interviews centered on key changes in the center's operation and on the adoption of key innovations. But a focus of the follow-up interviews still focused on medications provided for treatment.

The purpose of this study was to pilot test the potential for improvement in antiretroviral medication adherence of an adapted group-based, multi-session, community-based Antiretroviral Therapy (ART) adherence and risk reduction intervention, Project ADHerence Education and Risk Evaluation (ADHERE). Project ADHERE was compared to a single-session group-based medication adherence intervention, Medication Adherence and Care Engagement (MACE). A secondary aim was to examine the impact of Project ADHERE on HIV risk behaviors (i.e., illicit drug use and unprotected sexual behavior).

Formerly incarcerated Black drug offenders are at an elevated risk for HIV infection. Despite substantial research expressing the need for HIV prevention services for ex-offenders postrelease, this population has limited access to quality programming and services related to HIV risk reduction. This study seeks to inform and adapt an HIV risk reduction intervention to address the needs of formerly incarcerated Black drug offenders who are being released from prisons in the New York City metropolitan area. The study utilizes qualitative and quantitative methods to inform and adapt an HIV prevention intervention for this study population.

The Criminal Justice Drug Abuse Treatment Studies 2 (CJ-DATS 2) was launched in 2008 with a focus on conducting implementation research in criminal justice settings. NIDA's ultimate goal for CJ-DATS 2 was to identify implementation strategies that maximize the likelihood of sustained delivery of evidence-based practices to improve offender drug abuse and HIV outcomes, and to decrease their risk of incarceration.

The Medication-Assisted Therapy (MAT) study focuses on implementing linkages to medication assisted treatment in correctional settings. During the study period community corrections staff engaged in training about addiction pharmacotherapies, while leadership in the corrections and treatment facilities engage in a joint strategic planning process to identify and resolve barriers to efficient flow of clients across the two systems.

This study includes 28 datasets and over 1,400 variables. The first five datasets for this study contain data on the baseline characteristics of the treatment and corrections sites that participated in the study as well as the characteristics of the staff working at those facilities. Opinions about Medication Assisted Treatment surveys were administered to personnel at the participating corrections and treatment sites (D6). Data on Inter-organization Relations between Probation and Parole staff with Treatment Providers were also collected (DS7-DS18).

Information was extracted from the charts of clients about their alcohol and opioid dependence as well as the referrals and treatment the clients received (DS19). Probation and parole officers and treatment providers were surveyed about monthly counts of referrals (DS20-DS21).

During the study 10 staff members from the community corrections agency and local treatment providers where MAT services were available were nominated to participate in a Pharmacotherapy Exchange Council (PEC). PEC members were involved with strategic planning for implementing changes to improve the usage of Medication-Assisted Therapy. PEC members were surveyed several times throughout the study.

PEC members completed surveys on how well the sites were adhering to the Organizational Linkages Intervention (OLI) process (DS22). Community corrections staff, PEC members and Connections Coordinators in the experimental group were surveyed about their perceptions of organizational benefits and costs associated with the MATICCE intervention (DS23). The PEC rated the Connections Coordinators (DS24)and the Connections Coordinators rate the PEC (DS25). PEC researchers completed surveys on how much of the OLI was completed (DS26) as well as what the sustainability of the changes made through the MATTICE project (DS27). The final dataset provides a key for who took the KPI (Key Performance Indicators) training and who was a PEC member (DS28).