Health equity informed delivery of cognitive behavioral therapy for insomnia adapted for individuals with opioid use disorder - Project Summary Opioid use disorder (OUD) is a leading cause of death in the United States, with disparities in morbidity and mortality widening through the COVID-19 pandemic by race, ethnicity, sex and gender. Medications for OUD are life-saving, and increasing access, utilization and retention in evidence-based medication treatments for OUD is the most effective pathway forward to combat this public health crisis. Comorbid conditions common among people with OUD, such as insomnia, hinder OUD treatment retention and benefit, rendering patients at persistent overdose risk. Insomnia is prevalent in over half of patients receiving medication treatment for OUD, representing an ideal target for adjunctive treatments to medications for OUD aimed to improve health and re- covery outcomes. Cognitive Behavioral Treatment for Insomnia (CBT-I) is considered the gold-standard treat- ment for insomnia, yet its evidence is limited in OUD populations. Historically, behavioral therapies integrated into OUD treatment have demonstrated improved effectiveness when they are tailored to the specific biopsy- chosocial needs of this unique patient population. The objectives of this R34 application are to develop, refine, and preliminarily test the effects of a novel, integrated approach to treating insomnia in adults with comorbid opioid use disorder and insomnia. Utilizing a multiple prong approach through a health equity lens, we will de- velop, pilot test, and refine a Cognitive Behavioral Therapy for Insomnia and Opioid use disorder (CBT-IO). The proposed study will tailor CBT-I to OUD patient-reported biopsychosocial needs gained from preliminary qualitative data gathered from patients with insomnia and OUD receiving buprenorphine. We will adapt the CBT-I content (OUD specific information, such as anchoring sleep schedules to buprenorphine administration) and its delivery (utilizing telehealth vs. in person options for sessions based on barriers to access). We will take a multi-disciplinary approach to the intervention’s development and testing, incorporating a community-based expert panel review, and patient pre-testing using both qualitative and quantitative methods to evaluate the in- tervention’s feasibility, acceptability, and engagement. We will then examine the preliminary effects of the newly developed and refined intervention in a small, yet diverse, sample (N=56) of adults with comorbid insom- nia and OUD. Outcomes of interest include both sleep and substance use outcomes. Specific Aims include: AIM 1: Develop and refine a CBT-I intervention (CBT-IO) for individuals with OUD, which includes adapted content and a social determinants of health (SDoH) informed decision aid to guide individualizing treatment delivery route (telehealth vs. in person); AIM 2: Evaluate preliminary efficacy of CBT-IO to improve insomnia and OUD outcomes for individuals receiving medication treatment for their OUD. In line with NIDA’s call to ad- vance personalized medicine in addictions, this work develops and evaluates a novel treatment tailored for in- dividuals with OUD while also incorporating a health equity approach. Results will inform large scale studies to determine best methods for treating insomnia and OUD in at-risk samples of treatment seeking adults.
