Project Summary The Western States Node (WSN), a partnership between Oregon Health & Science University (OHSU), Stanford University/Palo Alto VA, University of California San Francisco (UCSF) and the San Francisco Department of Public Health, tests interventions to fill gaps in the addiction care cascade. Progressively fewer people who use drugs (PWUD) remain in care after each step in the cascade, resulting in unacceptably high morbidity and mortality. In concept and practice. Six diverse systems partner with the WSN to develop innovative CTN research: 1) Palo Alto VA and the national Veterans Healthcare Administration; 2) OHSU Health, 3) Stanford Hospital and Clinics, 4) Four community-based Opioid Treatment Programs serving rural and urban communities, 5) Low-barrier telehealth SUD programs, and 6) The PRIME+ network of 14 community-based peer organizations that provide outreach and harm reduction services to non-treatment- seeking PWUD in rural and urban communities. The WSN’s competing renewal application proposes collaborative research within the CTN that fills gaps in the addiction care cascade and enhances the lives of PWUD and their families and communities. Our addiction care cascade-focused research agenda was developed in conversations with our diverse team -- investigators, care providers, policy makers, and the WSN Community Council of PWUD and people in recovery. The Community Council prioritized the need to test new medications and behavioral treatments to initiate and retain people using fentanyl in care and to integrate peer support services into treatment and research settings, leading to two research agenda themes. Research Theme 1 seeks to close addiction care cascade gaps through treatment trials. An exemplar trial tests slow-release oral morphine induction versus standard buprenorphine inductions in 350 people who use fentanyl to improve buprenorphine treatment engagement and retention. Research Theme 2 seeks to integrate community-based peers into CTN trials that extend beyond traditional addiction treatment systems. WSN tests novel peer interventions to improve community-based outreach, treatment engagement and retention for diverse populations. WSN’s peer organization network amplifies the voices of peers in CTN research and brings an equity lens to expanding buprenorphine access and retention in rural and other under-served populations. WSN offers these resources to the CTN network for use in future CTN protocols. WSN continues to use the CTN as a platform for training, dissemination, and research applications. Our proposal seeks to reclaim approximately 225,000 years of healthy life lost each year to drug use in the U.S., and address NIDA’s Strategic Plan priorities to: a) develop and test novel treatment, harm reduction, and recovery support strategies, and b) study the implementation of evidence-based strategies in real-world settings.

Project Narrative The Western States Node is a collaboration across leading universities and health care organizations which develops and tests strategies that close gaps in the addiction treatment cascade. An exemplar trial tests slow-release oral morphine induction versus standard buprenorphine induction in 350 people who use fentanyl, to improve treatment engagement and retention. The trial, like the Node as a whole, also incorporates peers (individuals with lived experience in recovery) as advisors, research assistants, and supporters of high-quality care.