We propose a two-year competitive revision to 1UF1MH121954-01 to develop and then test an enhanced version of the parent study?s collaborative care intervention for co-occurring disorders (CC-COD) to reduce the risk of suicide and opioid-related overdose among individuals with opioid use disorder (OUD) in combination with PTSD/depression. The United States is in the middle of two intertwined epidemics. Suicide and overdose deaths are at record levels. Opioid use disorders and mental illness are major contributors to both, with the highest death rates seen in people with co-occurring disorders (COD). Medication for OUD (MOUD) can be life-saving, yet many individuals never receive treatment, and, of those who do, 50?80% drop out, putting them at increased risk of death. The parent study will provide a definitive answer as to whether collaborative care (CC) improves access, quality, and outcomes of care for individuals with COD. While a primary goal is to improve access to and retention in MOUD treatment (which is strongly linked to decreased mortality and overdose risk), the interventions CC-COD supports do not proactively address suicide or opioid-overdose risk, an important limitation. In addition, CC-COD does not include families in the patient?s care. We address these limitations and tackle the twin public health crises with the proposed revision. Because family members can play an important role in a patient?s decision to engage with treatment and in overdose and suicide prevention, we investigate family members? views and use this information to strengthen CC-COD. This revision will develop and then test the incremental effectiveness of three additional CC-COD components: CC care managers will (1) educate family members about addiction and MOUD; (2) train family members and the patient to administer naloxone and on how to reduce opioid risk behaviors, and (3) implement Caring Contacts, a suicide prevention intervention. We conduct our study in 13 primary care clinics in New Mexico, which is projected to have the nation?s highest death rate from drugs, alcohol, and suicide by 2025. The revision builds on the science of the parent study and uses the same infrastructure, methods and procedures. We add two additional clinics, which will increase our estimated enrollment and allow us to complete recruitment for both studies within the proposed timeline. Led by national leaders in the field, this study will be the first to examine patient and family member attitudes toward overdose education and naloxone in the population with COD; the first to examine and then intervene with family members around patients? use of MOUD; and the first to test in the COD population the effectiveness of universal suicide and overdose prevention programs, supported by the CC model. It will also expand the limited evidence base on how families can support a COD patient?s recovery. But most importantly, granting this proposal can dramatically enhance the original study?s impact on MOUD retention and suicide and overdose risk. Given that over 40% of suicide and overdose deaths were linked to opioid use in 2017, the time is right for tackling these twin epidemics.
Opioid use disorders, co-occurring with either depression or PTSD, are associated with high rates of suicide, overdose and mortality. This competitive revision tests whether enhancements to the collaborative care model adapted for co-occurring disorders improves MOUD treatment retention and decreases suicide and overdose risk. New Mexico has one of the highest opioid overdose death rates, and the CDC projects it will have the highest rates of death from drugs, alcohol and suicide in the nation by 2025.
