Project Summary
I am a well-published, early stage medical sociologist applying for a NIDA-funded Racial Equity Visionary Award
focused on the feasibility, acceptability, and preliminary efficacy of an innovative, mixed methods, community-
engaged intervention targeting non-Hispanic Black (NHB) individuals with opioid use disorder (OUD). This study
will apply my understanding of community needs and OUD, to test a novel intervention in a scalable setting,
leveraging my role as a leader in this field to disseminate findings and improve treatment access nationwide.
Opioid-related overdoses are increasing fastest in NHB individuals. In 2020, amid the COVID-19 pandemic, NHB
overdose deaths increased by 45%, nearly double the increase in non-Hispanic Whites (NHW). Disproportionate
increases in overdoses correspond to racial inequities in OUD treatment access and utilization. An effective
treatment, buprenorphine, is concentrated among communities with high percentages of NHWs, higher income,
and private insurance. Compared with NHW patients with OUD, NHB patients with OUD are 77% less likely to
have an office visit that includes a buprenorphine prescription, despite similar prevalence of OUDs. This
structural problem is at the foundation of my proposed research. Research focused on developing and testing
culturally effective, community grounded, and structurally competent OUD treatments with rigorous
implementation assessments is urgently needed to intervene on structural barriers to OUD treatment that
operate in settings in which NHB individuals seek healthcare. Significant federal funding has expanded access to
OUD treatment services in Community Health Centers (CHCs) that provide care to underserved populations and
areas but barriers to accessing care remain in NHBs. I propose to prepare for a fully powered clinical trial by
testing whether a buprenorphine treatment intervention protocol (Racial Equity in Systems to Treat Opioid Use
Disorder for Everyone—RESTORE) that targets structural barriers to OUD treatment for NHB individuals is
feasible in the context of CHCs. RESTORE draws upon concepts of structural competency, peer navigation, and
culturally grounded OUD education for both patients and providers. Community engagement will be continuous,
exemplified by the use of peer navigators to connect patients to care. RESTORE will be based in Southern
California—an epicenter of the nation’s opioid crisis. Project Phases, guided by cutting edge implementation
science, include 1) a qualitative investigation into provider and patient barriers to and facilitators of CHCs’
provision of buprenorphine specifically to NHB individuals with OUD; 2) the operationalization of RESTORE into
routine care, using preliminary findings from Phase I; and 3) a pilot stepped-wedge randomized controlled trial
to test the feasibility, acceptability, and preliminary efficacy of RESTORE, as well as the protocols, procedures
and training in CHCs. This study has the potential to improve effective treatment rates in 4 clinics and provide
an evidence-based intervention to be tested at scale across multiple states. Improvements in local treatments,
designed to reach NHBs, will greatly reduce the current increase in overdose disparities.
