Project Summary/Abstract The overall goal of this proposed Mentored Patient-Oriented Research Career Development Award (K23) is for the candidate, Dr. Sarah Messmer, to become an independent investigator in implementation science and substance use disorder treatment, with a focus on opioid use disorder treatment in low-barrier and community- based settings. Given that opioid overdose deaths have reached an all-time high in the United States, the development and implementation of evidence-based interventions to treat opioid use disorder is critical. To become an independent investigator in this area, the candidate requires additional formal training in the following areas: 1) implementation science in substance use disorder research; 2) clinical trials design; and 3) ethical considerations in substance use disorder research. The candidate’s mentorship team includes Dr. Niranjan Karnik, Dr. Sara Becker, Dr. Dennis Watson, and Dr. Rachel Caskey, who will support the candidate in the proposed training and research plan. The overall objective of the proposed research is to implement an adapted contingency management program within a mobile low-threshold buprenorphine program. Contingency management is one of the most effective behavioral health treatments for substance use disorder, including when provided concurrently with medication for opioid use disorder. However, implementation barriers have limited its use, particularly in community-based settings. This proposal seeks to engage diverse stakeholders to identify implementation barriers and develop targeted implementation strategies that can be utilized for contingency management programs within community-based, low-barrier settings, with a primary goal of increasing retention in care for patients with opioid use disorder. The proposal will be guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) implementation framework, with the ADAPT process model embedded to guide the stages of adaptation. In Aim 1, the candidate will complete focus groups and interviews with a group of diverse stakeholders including people who use drugs, community harm reduction programs, policymakers, researchers, and substance use treatment providers to identify barriers and facilitators for the intervention. In Aim 2, the candidate will work with an adaptation team of key stakeholders to adapt a contingency management program and develop an implementation plan for use in a low-barrier mobile setting. In Aim 3, the candidate will conduct a 12-week pilot study of the adapted contingency management program and corresponding implementation strategies with patients with opioid use disorder engaged in low- threshold treatment via mobile van. The outcomes of this study will provide the foundation for an R01 proposal for a larger clinical trial of the adapted intervention. This award would provide Dr. Messmer with the mentorship, training, and research experience to become an independent investigator in implementation science and substance use disorder treatment focused on community-based low-barrier care models.

Project Narrative Contingency management is one of the most effective behavioral health tools available for substance use disorder treatment, yet it is one of the least available to patients due to implementation barriers. This proposed research seeks to adapt a contingency management program to fit a new context within a low-threshold buprenorphine program providing services to patients with opioid use disorder via mobile van. Given the worsening opioid overdose crisis in the United States, this project has the potential for a significant public health impact by contributing to knowledge on how to adapt and implement contingency management to make it more accessible to patients with opioid use disorder, particularly those at highest risk of overdose death.