Abstract Emerging adults (ages 16-25) have been particularly impacted by the opioid crisis. Although medications are crucial for reducing mortality, return to opioid use, and other harms associated with opioid use disorder (OUD), persons in recovery who take or who have taken medications for OUDs (MOUDs) have many unmet needs and ongoing risk factors that prevent their return to full functioning and to flourishing. The recovery needs of EAs following stabilization on MOUDs are not well documented and are likely unique to this age group. EAs face developmental milestones characterized by frequent transitions and instability in education, housing, and relationships. The recovery needs of EAs taking MOUDs are further complicated by high rates of co-occurring mental health disorders, polysubstance use, and premature discontinuation of MOUDs. Recovery support services, particularly clinical continuing care delivered after a treatment episode, are likely to play a key role in the long-term management of OUD for EAs. Although such services can be found across the spectrum of real- world substance use treatment, very little high-quality research has evaluated the efficacy or effectiveness of recovery support services or continuing care specific to the needs of EAs. Further, continuing care research has been largely researcher-driven and focused on abstinence, symptom reduction, and reducing cost, rather than fostering recovery capital and the full range of outcomes valued by EAs in recovery from OUD. Genuine partnerships and collaborations are needed to ensure research on continuing care reflects the values and needs of EAs taking MOUDs. We will advance this critical but under-researched area by building a multidisciplinary, community-engaged network: The Continuing Care Hub for Emerging Adult Recovery Research (CHEARR). Our proposed team has extensive expertise in recovery support services, research with real-world substance use treatment organizations, and partnerships with agencies that serve EAs taking MOUDs. We propose three overarching goals that each provide actionable deliverables: (1) use a community-based participatory approach to develop the critical tools to conduct high-quality research in this area by creating and partnering with two community boards comprised of EAs who take or who have taken MOUD and recovery supports specialists who have expertise with EAs; (2) provide a hub of science on continuing care for EAs on multiple platforms to educate and engage the larger scientific community, communities impacted by OUD, and other key partner communities; and (3) create a trainee-to-investigator pipeline through a) a postdoctoral fellowship and student internship program and b) funding pilot studies that will produce preliminary data for NIH grant applications. In addition, the CHEARR team and community boards will partner to develop an EA-specific measure of recovery capital, a crucial tool that is currently missing from the scientific literature. Psychometric data on this measure will be collected as part of the pilot study program. Through these aims, CHEARR will foster rapid expansion of science and develop the infrastructure necessary to investigate continuing care services for EAs taking MOUD.

Project Narrative The consequences of the opioid epidemic have been particularly devastating to emerging adults (ages 16-25). Recovery supports services have become common in community settings and have the potential to help emerging adults taking medications for opioid use disorder to maintain long-term reductions in opioid use, to return to functioning, and to flourish, yet infrastructure to support science on these topics is lacking. This project will develop a network of advanced researchers, recovery support specialists, emerging adults in recovery, and other key partner communities to help rapidly advance the science on recovery support services, particularly clinical continuing care, that are specialized for emerging adults who take or who have taken medications for opioid use disorder.