The MOUD Plus Pilot: Counseling and Peer Support to Support Retention for Medically Complex Patients With Opioid Use Disorder Seen In Primary Care
NCT ID: NCT06837662
Last Updated: 2025-12-18
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
NA
70 participants
INTERVENTIONAL
2025-03-24
2026-11-01
Brief Summary
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The main questions it aims to answer are:
* Does the addition of a counseling and peer referral interventions in addition to usual primary care with low-threshold buprenorphine increase retention on medications for opioid use disorder?
* Does the addition of counseling and peer referral intervention in addition to usual primary care with low-threshold buprenorphine increase engagement in primary care?
Researchers will compare the MOUD "Plus" intervention compared to primary care treatment as usual low-threshold buprenorphine prescribing practice to see if MOUD "Plus" improves retention and engagement.
Participants will upon screening and enrollment:
* Meet with prescribers who will determine dose of buprenorphine and assess other medical issues as per treatment as usual with visits every 2-4 weeks
* Meet with the integrated addictions counselor to develop rapport and support around clinic engagement, brief counseling intervention, and coordination of care in support of their MOUD
* Be referred to a community based peer who meets with participants outside the clinic for support and advocacy for patient directed recovery goals
* Meet with the research coordinator at 2, 3, and 6 months to complete follow-up surveys about their care and experiences
Detailed Description
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The hypothesis is that this team-based intervention, called "MOUD-Plus", consisting of prescribers along with integrated substance use counselor, and referral to community based peer recovery support, can improve care engagement and retention on MOUD by increasing engagement, building trust, and offering patient directed therapeutic and peer-enhanced support for their treatment on MOUD.
Main existing components of MOUD: ("Treatment as Usual")
1. Scheduled or Walk in clinic M-F 8-5 pm
2. Visits with buprenorphine waivered prescriber
3. Prescribers are trained to initiate and continue treatment same day ("low threshold" prescribing)
4. Connection to usual primary care services
5. On-site lab, pharmacy, and screening for HIV, hep C with referral to treatment
"MOUD Plus": New Components to support OUD and medical complexity
1. Engagement with an Integrated Substance Use Disorders (SUDS) Counselor for medical complexity to aid in rapport building, brief counseling interventions (e.g., motivational interviewing, harm reduction counseling), and care coordination.
2. Referral and coordination with outside peer organizations that work with the program to assist medically complex clients to support self-efficacy and treatment goals.
3. Enhanced care coordination and panel management to address continuity of care and medication management for those enrolled.
Outcomes:
1. Retention on medication for opioid use disorder (MOUD) at 2, 3-months (primary), and 6-months
2. Engagement with care teams at 2, 3, and 6-months (secondary, mechanism of action)
3. Change in trust in care team, and recovery capital at 2 months, 3, and 6-months (secondary outcomes)
4. Assess feasibility, acceptability, and potential scalability of the program using the RE-AIM-QuEST framework
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
1. Engagement with an Integrated Substance Use Disorders (SUDS) Counselor for medical complexity to aid in rapport building, brief counseling interventions (e.g., motivational interviewing, harm reduction counseling), and care coordination.
2. Referral and coordination with outside peer organizations that work with the program to assist medically complex clients to support self-efficacy and treatment goals.
3. Enhanced care coordination and panel management to address continuity of care and medication management for those enrolled.
SUPPORTIVE_CARE
DOUBLE
Study Groups
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MOUD Plus Arm (treatment as usual + integrated counseling and peer referral)
Treatment as usual (prescriber trained in low threshold MOUD prescribing practices) plus coordinated warm-handoffs with integrated counseling services and coordinated referral to community based peer services
MOUD "Plus" Intervention (treatment as usual + coordinated counseling and referral to community based peer)
In addition to treatment as usual (clinic visits for primary care and MOUD), patients will meet with clinic based addictions counselor who provides 1) rapport building ; 2) brief counseling interventions (e.g. motivational interviewing, change talk/solutions based therapy, harm reduction counseling); 3) referral to community resources. Patients will also be referred to community based peer recovery services who are credentialed and trained to "meet the person where they are" in the community and provide advocacy and support for client directed goals.
Treatment as usual Arm (low threshold MOUD prescribing in primary care)
Current treatment as usual consists of scheduled appointments with prescribers who are trained in low-threshold MOUD prescribing practices and who are part of a patient centered medical home model of care
Treatment As Usual (primary care with low threshold MOUD prescribing)
Treatment as usual arm consists of primary care clinical appointments with prescribers who treat medical issues and are trained to diagnosis and treat OUD using low threshold prescribing approaches.
Interventions
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MOUD "Plus" Intervention (treatment as usual + coordinated counseling and referral to community based peer)
In addition to treatment as usual (clinic visits for primary care and MOUD), patients will meet with clinic based addictions counselor who provides 1) rapport building ; 2) brief counseling interventions (e.g. motivational interviewing, change talk/solutions based therapy, harm reduction counseling); 3) referral to community resources. Patients will also be referred to community based peer recovery services who are credentialed and trained to "meet the person where they are" in the community and provide advocacy and support for client directed goals.
Treatment As Usual (primary care with low threshold MOUD prescribing)
Treatment as usual arm consists of primary care clinical appointments with prescribers who treat medical issues and are trained to diagnosis and treat OUD using low threshold prescribing approaches.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Have an OUD-related diagnosis (e.g. Opioid Use Disorder in remission, Opioid Dependence, Opioid Abuse, Substance Use Disorder - opioids, etc.), or have used fentanyl or heroin over the past 30 days
* Who meet at least one of the following criteria:
* Present to primary care at Central City Concern (CCC) within 8 weeks of starting or re-starting a treatment episode (defined as starting MOUD after not having received prescribed MOUD in an outpatient setting for OUD in the prior 30 days).
* Who present to primary care at CCC and are not seeking treatment with MOUD and have not engaged in counseling services (e.g. harm reduction counseling) in the prior 30 days
* Have been receiving MOUD in prior 30 days but had a return to use (used fentanyl or heroin) within the past 30 days
* Medical complexity (e.g. self-reported or verified in patient's electronic health record)
* Have access to phone and/or computer for follow-up activities
* Desire to engage in counseling and/or peer services
Exclusion Criteria
* Patient participants who are not able to verbally consent may not participate in the study.
* Patients who do not have addiction to opioids may not participate in the study.
* Patients who participated in Aim 2 would not be eligible for Aim 3
* Patients who lack stable phone access may not participate in the study.
18 Years
ALL
No
Sponsors
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National Institute on Drug Abuse (NIDA)
NIH
Central City Concern
UNKNOWN
Oregon Health and Science University
OTHER
Responsible Party
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Brian L Chan
Associate Professor
Principal Investigators
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Brian Chan, MD MPH
Role: PRINCIPAL_INVESTIGATOR
Oregon Health and Science University
Locations
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Central City Concern
Portland, Oregon, United States
Countries
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Central Contacts
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Principal Investigator
Role: CONTACT
Phone: 503-494-2010
Facility Contacts
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Research Coordinator
Role: primary
Other Identifiers
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STUDY00024006
Identifier Type: -
Identifier Source: org_study_id