Health Systems Node of the NIDA Clinical Trials Network (CTN-0139)

Kaiser Foundation Research Institute, Oakland CA

Investigators

Linked publications, trials & patents

Abstract

Substance use (SU) and substance use disorders (SUDs) are among the greatest causes of chronic illness and death in the United States. High potency synthetic opioid (i.e., fentanyl) and stimulant use has contributed to a national overdose crisis. In addition, polysubstance use is increasing, complicating treatment of opioid use disorder, and greater availability of high potency cannabis is increasing adverse health outcomes due to cannabis use disorder (CUD). There is a critical need to prevent overdose deaths among youth and adults and improve outcomes of SUD. However, most people with SUD do not receive treatment. Effective and scalable treatments are needed to prevent deaths due to SU and SUD. In addition, it is critical to increase SUD treatment utilization to improve outcomes. This requires methodological innovation: new ways to engage patients, statistical methods for rigorous pragmatic trials in large populations in multiple sites across the US, 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 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: demonstrating that primary care nurse care managers can markedly increase opioid use disorder treatment; increasing safety of opioid prescribing; evaluating optimal duration of buprenorphine for improving survival; and validating novel and practical measures of cannabis use and SUD. The Node’s long-term objective is to improve SU and SUD and related outcomes in real world settings. The Node’s Research Agendas are to: 1) improve health outcomes of SU and SUD for individuals who are not in treatment by testing novel interventions designed to prevent overdose deaths and other adverse consequences of SU; 2) improve SUD treatment for individuals seeking treatment by conducting trials that test innovative treatment approaches that support short and long-term recovery in real world medical settings; and 3) improve the rigor of pragmatic trials through innovations in qualitative methods to increase engagement of individuals with SUD; through new statistical methods; and through measurement using individually reported outcomes to measure change over time in large clinical populations. The Node will partner with 18 health systems across the United States prepared to conduct pragmatic trials (12 large health systems in the Health Care Systems Research Network, 3 primary care networks, the Veterans Health Administration, and 2 external hospitals). 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, over the next 7 years the Node will focus on creating scalable and effective systems of SU and SUD prevention, treatment and recovery.