PROJECT SUMMARY/ABSTRACT: The Tailored Retention and Engagement for Equitable Treatment of OUD and Pain (TREETOP) clinical research center at the University of Pittsburgh (Pitt) is part of the NIH IMPOWR network. TREETOP draws on the NIDA Clinical Trials Network Appalachian (Pennsylvania & West Virginia) and Western States (Oregon) Nodes and the Community-based OUD and Pain Enhanced treatment (COPE) collaborative (Baltimore, Maryland) to develop effective, equitable, and sustainable interventions for chronic pain and OUD. Our overall goal is to improve treatment for comorbid chronic pain and OUD across the OUD Treatment Cascade, prioritizing two disproportionately impacted communities for whom equitable implementation of effective interventions can be challenging: rural and Black communities. We will achieve our overall goal through the integrated contributions of 5 center components as follows: 1) Research Site Overview, Management, and Operations - Our diverse multidisciplinary team has extensive experience with multisite clinical trials as well as in TREETOP’s two emphasis areas, health equity and implementation science. 2) Engagement and Outreach - Our TREETOP Stakeholder Consultation Board (SCB) includes representatives with a variety of perspectives and lived experiences from each clinic and community partnering in our studies and will serve as active participants on the research team. 3) Engagement/Retention Research Projects - Both projects share the central premise that treating chronic pain improves pain and OUD outcomes, tailor a pain self-management (PSM) intervention to patients with co-morbid chronic pain and OUD, and evaluate both the intervention effectiveness and the barriers and facilitators to equitable and sustained implementation of the intervention through the Health Equity Implementation Framework. Specifically, the Engagement research project investigates whether PSM can improve pain and engage primary care patients in medication treatment for OUD, while the Retention project investigates whether PSM and/or flexibly dosed buprenorphine/naloxone can improve pain and retention in treatment among patients who have already initiated care in office-based addiction treatment programs. 4) Data Collection, Management, and Harmonization - The Data Core will be led by investigators with a track record of success in the measurement and analysis of patient-reported outcomes and in leading clinical trials and data coordinating centers, and includes national leaders in the PROMIS Health Organization. 5) Pilot Projects - Our Pilot program includes 3 initial studies on pain measurement, chronic pain/OUD treatment implementation in specialty settings, and chronic pain and OUD stigma, and then follows a standard protocol for soliciting and reviewing future pilot projects addressing health equity and implementation science. Overall Impact: Our TREETOP investigators and SCB will collaborate to advance the science of sustainably and equitably managing chronic pain and OUD, prioritizing disproportionately impacted rural and Black communities.

Project Narrative: We will create the Tailored Retention and Engagement for Equitable Treatment of OUD and Pain (TREETOP) clinical research center, an IMPOWR clinical research center at the University of Pittsburgh (Pitt) that develops effective, equitable, and sustainable interventions for chronic pain and OUD that improve engagement in medication for OUD treatment and retention in office-based addiction treatment. TREETOP will prioritize two disproportionately impacted communities for whom equitable implementation of effective interventions can be challenging: rural and Black communities. TREETOP’s success will not only advance the science in this area but will advance the professional development of early- career investigators and help grow our field long-term.