The study is designed as a randomized clinical trial of opiate abusers and their drug networks to assess efficacy of the experimental Peer Mentor condition on (a) overdose prevention and care education to drug network members, (b) naloxone availability, and (c) drug treatment readiness and entry. The proposed study is based on our previous research, pilot studies, and the research of other investigators who have demonstrated that social networks can be capitalized on to develop robust and sustainable interventions for behavior change among opiate users. 300 index participants will be enrolled in the study. Index participants will be asked to recruit at least 1 network member who is also a current opiate user. Half of the index participants will be randomly assigned to the comparison condition and half to the experimental condition (peer mentor intervention), which consists of 3 individual sessions focused on education of their network members for promoting drug treatment, overdose prevention and care, and providing naloxone to network members. Index and network participants will be assessed with face-to- face interviews and drug toxicology at 3, 6, 9, & 12 months. It is anticipated that through active learning, cognitive dissonance, and social identity processes, index participants in the experimental condition will be more likely to change their drug overdose behaviors and increase treatment readiness as compared to those in the equal attention comparison condition. Social diffusion of behavior change will also be assessed in the network members of the indexes. Index participants will also be encouraged to recruit family and friends to receive naloxone and overdose prevention and care training at our community clinic. At the 6-month assessment, based on drug treatment enrollment rates in our prior studies, we expect at least 250 of the index participants will not be in drug treatment but indicated for treatment. Indexes in both conditions who report using drugs at the 6-month assessment will receive an individual session focused on drug treatment entry and drug treatment as the next logical step in being a Peer Mentor. At the 9-month assessment, a second drug treatment session will be offered to indexes who meet criteria for drug dependence and drug treatment.
The proposed study is relevant to key public health issues among opiate users and their social network members of drug overdose and drug treatment. The study is designed to maximize the impact through social diffusion. It is also designed to be low cost, sustainable, and easily implemented by CBOs and local health departments.