This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction. Over 100,000 people died from drug overdoses in 2021, underscoring the need for urgent action. While the rates of overdose deaths among White people have begun to plateau, there has been a drastic surge in deaths among racial/ethnic minoritized individuals. There are also stark disparities from other substance use, including stimulants among Black and Latinx people who use drugs (PWUD). While effective treatment exists for problematic substance use, along with harm reduction (HR) services that decrease substance-related harms, studies demonstrate that racial/ethnic minoritized people are less likely to have access to these services. They not only experience more negative consequences related to substance misuse but are also less likely to receive HR services or be retained in evidence-based treatment such as MAT. To tackle these unique problems, we created an integrated harm reduction intervention (IHRI) to be mobile and flexible to the needs of Black and Latinx PWUD. This culturally responsive IHRI will employ a HR care coordinator that can assess vulnerabilities in the social determinants of health (SDOH) and link people to needed services. Data from community partners who operate HR services and serve largely Black and Latinx PWUD suggests that participants who receive HR services have significant improvements in health and engagement. Yet, systemic barriers to additional social services NOT directly related to substance use persist, which often influence health outcomes and quality of life. Thus, offering a low barrier, geographically distributed, culturally informed HR intervention in historically excluded communities may prove a highly disseminable strategy, for improving access to HR services and MAT. We plan to evaluate the efficacy of this integrated HR intervention (by providing legal, housing and mental health treatment support, along with linkage to MAT) on participant retention and engagement of HR services among n=200 Black and Latinx PWUD compared to services as usual in two mobile Community Harm Reduction Organizations. The escalating overdose death rates among Black and Latinx PWUD is a serious public health. The focus on health disparities in addiction is of high priority to NIDA and may prove a useful model for decreasing harm and broadening MAT access for Black and Latinx PWUD, who have been historically excluded these services in traditional settings.

Project Narrative We propose to develop and test the effectiveness of an 8-week integrated Harm Reduction (HR) intervention on participant initiation and engagement of HR services among Black and Latinx PWUD compared to services as usual in two mobile Community Harm Reduction Organizations, in Bronx, NYC and New Haven, CT. This integrated HR service intervention will provide a care coordinator with lived experience to identify the vulnerabilities in the social determinants for Black and Latinx PWUD and connect them to local partnering organizations for housing, legal, and mental health/substance use treatment. If effective, this intervention could prove a valuable strategy in minimizing morbidity and mortality amongst Black and Latinx PWUD, two historically excluded groups known to be disproportionately affected by the drug overdose crisis, providing a pathway to fuller lives in the community.