Project Summary/Abstract Substance use (SU) and substance use disorders (SUDs) are among the greatest causes of disability and death in the United States. High potency synthetic opioid and stimulant use has contributed to a national overdose crisis. Moreover, overdose deaths are increasing among Black, Hispanic, American Indian, and Alaskan Native communities, and youth. In addition, greater availability of high potency cannabis is increasing the risk of cannabis use disorder (CUD). There is a critical need to prevent overdose deaths and improve outcomes among people with SUD. However, most people with SUD do not receive treatment. Effective and sustainable interventions are needed to prevent deaths due to SU and SUD and increase equitable access to treatment. This requires methodological innovation: new ways to engage underserved populations, statistical methods for rigorous pragmatic trials in large, heterogeneous populations, and improved measures of SU and SUD for clinical care and research. Health Systems Node investigators, led by Drs. Campbell, Bradley, and Binswanger (multiple PIs), are experts in pragmatic, multi-site studies in large and diverse medical settings, and are poised to address the above challenges. Node investigators have conducted high impact research in the National Drug Abuse Treatment Clinical Trials Network (CTN) since 2015: validating novel and practical measures of cannabis use and CUD; identifying risks of rapid opioid tapers; evaluating duration of buprenorphine and survival after discontinuation; and demonstrating that primary care nurse care managers can increase opioid use disorder treatment. The Node’s long-term objective is to improve SU and SUD and related outcomes across diverse populations in real world settings, decreasing SU and SUD disparities. The Node’s Research Agendas are to: 1) improve health outcomes of SU and SUD for people who are not in treatment, including preventing overdose deaths; 2) improve SUD treatment for all people seeking treatment; and 3) improve the rigor and person-centeredness of SU and SUD pragmatic trials through methodological innovation. The Node will partner with 19 health systems across the United States prepared to conduct pragmatic trials (13 large health systems in the Health Care Systems Research Network, 3 networks of Federally Qualified Health Centers, the Veterans Health Administration, and 2 external hospitals). The Node’s Plan to Enhance Diverse Perspectives includes conducting research in underserved populations; increasing the inclusion and success of investigators from underrepresented groups; and increasing the voice of people with lived experience of SU and SUD in all phases of Node research. Impact. The Health System Node’s practical and population-based research has transformed SU and SUD care in real world settings. Building on prior success, in the next period the Node will focus on creating accessible, equitable, scalable, and effective systems of SU and SUD prevention and treatment to improve outcomes of SU and SUD for all people.

Project Narrative The diverse health systems in the Health Systems Node have nation-wide reach and embedded researchers conducting practical substance use research in real world health care settings. The Node’s research agendas are to conduct research that: improves outcomes for people who are not in treatment, including preventing overdose deaths; improves substance use disorder treatments available for all people seeking care; and improves the rigor and person-centeredness of substance use and substance use disorder pragmatic trials through methodological innovation. The Node’s Plan for Enhancing Diverse Perspectives will support equity and inclusion in all Node activities, enhancing the impact of the Node’s research.