PROJECT ABSTRACT Opioid use disorder and overdose deaths represent a national public health crisis that has been particularly acute in central Appalachia for decades. While treatment access and engagement are improving across Appalachia, the quality of the recovery support ecosystem is reflected in the small percentage of individuals who successfully maintain treatment with medications for opioid use disorder (MOUD) or abstain in recovery. An interface of community and treatment, peer recovery support services (PRSS) are a particularly high value proposition to enhance treatment outcomes and the recovery process, though one for which there is currently limited evidence to inform the content of their practice and use, particularly in the context of MOUD. While research to advance recovery support services is urgently needed in central Appalachia, insufficiencies in basic infrastructure, such as research capacity, engaged clinical research sites, and data infrastructure remain barriers to PRSS implementation and study. In response, the Studies To Advance Recovery Support (STARS) Network, a thematic, stakeholder-focused research network, will be initiated from an established regional research consortium—the Opioids Research Consortium of Central Appalachia (ORCCA). The following network aims will be executed by leveraging assets inherent to ORCCA and concentrating on PRSS for individuals treated in the context MOUD clinics: 1) build university and health system partner capacity to conduct community-engaged PRSS research; 2) enroll cohorts of MOUD clinics and PRSS professionals to foster commitment to engage in rapid conduct of PRSS studies; 3) advance processes and technologies to harmonize data and research efficiencies that advance PRSS studies across institutional partners; and 4) advance STARS network capacity to conduct rapid-cycle intervention research using rigorous designs. A dynamic team, jointly led by established ETSU and Virginia Tech researchers and facilitated by ORCCA institutions and PRSS partners with lived experience in recovery, offer assurance of successful execution. The proposed work is innovative because it aligns assets of an established opioids research consortium for maximum efficiency, demonstrates a novel application of the Recovery Ready Ecosystem Model, and creates rigorously developed assessment tools and critical cohort platforms of PRSS professionals and MOUD clinics for the purpose of recovery research. The proposed work is significant because the expected outcomes and products will mitigate current barriers to, and establish a foundation for, high-priority PRSS research in the central Appalachian region (KY, TN, VA, WV), a region devastated by the opioid crisis. Consistent with the NIDA mission, our long-term goal for this work is to inform the expansion of recovery support services, particularly PRSS, and advance recovery among individuals treated with MOUD.

PROJECT NARRATIVE Recovery support services, alongside access to medications for opioid use disorder, are rapidly expanding in the wake of the opioid crisis, yet rigorous research on recovery support services continues to lag behind. The proposed activities will initiate the Studies To Advance Recovery Support (STARS) Network, a thematic, stakeholder-focused research network that will capitalize on an established research consortium to generate trainings, tools, and platforms targeted to the implementation and study of peer recovery support services for individuals treated with medications for opioid use disorder. The STARS Network is relevant to public health because it will provide a critical foundation for high-priority research on peer recovery support services that could inform the expansion of peer recovery support services and advance recovery among individuals with opioid use disorder.