PROJECT SUMMARY/ABSTRACT The evolving landscape of opioids, methamphetamine, legalized cannabis, and effects of structural racism and stigma have led to prioritization of several themes in addiction treatment research. Marginalized and under- represented minority populations continue to disproportionately bear the burden of SUDs and co-occurring mental illness, and their voices must be included in research foci, workforce training, and relevant dissemination. Innovations in MOUD treatment, overdose prevention, harm reduction strategies, and novel therapeutics and technologies are needed to address the leading challenges in SUD treatment. The NIDA National Drug Abuse Treatment Clinical Trials Network (CTN) has prioritized these challenges. To contribute to the CTN’s objectives and research priorities, the Pacific Northwest (PNW) Node proposes the following Specific Aims: 1) Increase capacity of the PNW Node research team to ensure inclusion of populations experiencing structural inequities by expanding investigators with practical and clinical expertise in opioid, methamphetamine, and other drugs of abuse; substance use impacts on youth and families; emerging behavioral, neuromodulation and pharmacologic treatments; SUD treatment access in primary care (PC); and harm reduction strategies in community settings serving stigmatized, BIPOC, and minoritized or under-served populations. 2) Expand scope, population, diversity, and focus of PNW Node’s roster of research, practice, and dissemination settings by including new settings for SUD treatment and PC, and partnerships with individuals and organizations focusing on drug and alcohol related policy in the Pacific Northwest. This will strengthen our continued focus on structural inequity, including BIPOC; people living in rural areas; youth and families; people with lived experience; individuals with co-occurring substance use and mental or physical health disorders; and gender and sexual minorities. 3) Design and conduct pragmatic, comparative effectiveness, implementation, data science, and other types of studies that evaluate novel behavioral, pharmacological, and technology-based treatments for opioids, methamphetamine, and cannabis. Studies will be informed bi-directionally by SUD researchers, clinicians, primary and acute care providers and our community advisory board, and enhanced where appropriate by use of Electronic Health Records, with emphasis on BIPOC study recruitment. 4) Provide dissemination, workforce training, and technical assistance to affiliated SUD and healthcare providers, researchers, and the public about SUDs, medication treatments, and behavioral interventions integrated into settings serving people who use substances. We will use strategic cross-node collaborations and UW/WSU training, technical assistance and dissemination programs to complete this work.

PROJECT NARRATIVE Many people with substance use disorders (SUDs) do not seek treatment through specialty SUD programs. People from under-represented groups and with co-occurring medical and mental health conditions need SUD treatment or harm reduction to be integrated into the community settings they attend. Research on improved treatments and technologies is needed, to better engage these individuals across diverse primary care, acute care, remote-rural, low barrier, and specialty medical settings.