Project Summary/Abstract
The overall goal of this proposed Mentored Patient-Oriented Research Career Development Award (K23) is for
the candidate, Dr. Sarah Messmer, to become an independent investigator in implementation science and
substance use disorder treatment, with a focus on opioid use disorder treatment in low-barrier and community-
based settings. Given that opioid overdose deaths have reached an all-time high in the United States, the
development and implementation of evidence-based interventions to treat opioid use disorder is critical. To
become an independent investigator in this area, the candidate requires additional formal training in the
following areas: 1) implementation science in substance use disorder research; 2) clinical trials design; and 3)
ethical considerations in substance use disorder research. The candidate’s mentorship team includes Dr.
Niranjan Karnik, Dr. Sara Becker, Dr. Dennis Watson, and Dr. Rachel Caskey, who will support the candidate
in the proposed training and research plan. The overall objective of the proposed research is to implement an
adapted contingency management program within a mobile low-threshold buprenorphine program.
Contingency management is one of the most effective behavioral health treatments for substance use disorder,
including when provided concurrently with medication for opioid use disorder. However, implementation
barriers have limited its use, particularly in community-based settings. This proposal seeks to engage diverse
stakeholders to identify implementation barriers and develop targeted implementation strategies that can be
utilized for contingency management programs within community-based, low-barrier settings, with a primary
goal of increasing retention in care for patients with opioid use disorder. The proposal will be guided by the
Exploration, Preparation, Implementation, Sustainment (EPIS) implementation framework, with the ADAPT
process model embedded to guide the stages of adaptation. In Aim 1, the candidate will complete focus groups
and interviews with a group of diverse stakeholders including people who use drugs, community harm
reduction programs, policymakers, researchers, and substance use treatment providers to identify barriers and
facilitators for the intervention. In Aim 2, the candidate will work with an adaptation team of key stakeholders to
adapt a contingency management program and develop an implementation plan for use in a low-barrier mobile
setting. In Aim 3, the candidate will conduct a 12-week pilot study of the adapted contingency management
program and corresponding implementation strategies with patients with opioid use disorder engaged in low-
threshold treatment via mobile van. The outcomes of this study will provide the foundation for an R01 proposal
for a larger clinical trial of the adapted intervention. This award would provide Dr. Messmer with the
mentorship, training, and research experience to become an independent investigator in implementation
science and substance use disorder treatment focused on community-based low-barrier care models.