This renewal application to conduct research in the NIDA Clinical Trials Network has broad public health implications focused on developing and testing ways to better treat medical problems and addiction through integrated care. The project will conduct clinical trials of treatments for drug use disorders in the context of primary care addressing hepatitis C, HIV, and opioid overdose--topics of urgent national importance. This research can accelerate the advancement of providing integrated treatments for medical problems and addiction in the coming years.
The Western States (WS) Node of the National Drug Abuse Treatment Clinical Trials Network (CTN) promotes evidence-based drug abuse prevention and treatment services through continued participation in the CTN. The Node 1) designs and implements clinical trials of evidence-based treatments of addiction through rapid recruitment of diverse study participants in partnership with NIDA and the CTN, 2) generates peer-reviewed publications in collaboration with treatment providers and other nodes, and 3) uses the CTN as a platform for training, dissemination, and research applications. The Regional Research and Training Center includes talented faculty and staff from Oregon Health & Science Center and University of California, San Francisco as well as leaders of affiliated healthcare partners providing integrated primary care and substance use disorder treatment. The Node was created in 2010 as an amalgam of two CTN Nodes--California-Arizona and Oregon/Hawaii (a charter member of the CTN). The Node was highly successful, during the current award, participating in 10 CTN trials, co-leading two of these and leading one; reporting results of CTN main studies, ancillary, and research using the CTN platform in 100+ publications, and actively disseminating evidence- based practices in 200 presentations. Node investigators also sought and received awards for 10 studies that used the CTN as a platform for research. Eight WS Node healthcare programs recruited over 1,300 participants into CTN studies. In the coming grant period the Node expands to include three national and regional primary care and HIV primary care research networks: OCHIN, the HIV Research Network, and the Oregon Rural Practice-Based Research Network (ORPRN). The Node retains core addiction treatment centers experienced in CTN protocols and exploits their links with primary care: Adapt (Roseburg, OR), CODA (Portland, OR) HealthRIGHT 360 (San Francisco, CA), La Frontera (Tucson, AZ), NARA (Portland, OR), and Signal Behavioral Health Network (Denver, CO). The Node's research agenda proposes study concepts that evaluate three strategies to integrate and enhance addiction treatment within healthcare settings. Study 1 builds a patient registry for HCV infection and tests a multi-contact brief intervention for alcohol use. Study 2 extends the registry testing a candidate therapeutic HIV vaccine. Study 3, a test of reverse integration (primary care clinicians in addiction treatment settings), assesses naloxone distribution and education to reduce fatal and nonfatal opioid overdoses and measures impact on return to use. Finally the WS Node continues to use the CTN as a platform for training, dissemination, and research applications. The Node has the potential to accelerate the advancement of integrated primary care and addiction in the coming years.