PROJECT SUMMARY
Black and Latinx people who use opioids (PWUO) bear a disproportionate burden of opioid-related overdose
deaths. Racial disparities among PWUO are exacerbated by persistent socioeconomic and structural barriers
(e.g., stigma, lack of social support, housing instability) which may be partially addressed using scalable open-
source solutions (e.g., peer recovery coaches, mobile health, telemedicine). With NIH support, we have
validated a theory-based, AI-driven texting using natural language processing in a publicly-funded health system
to provide real-time responses to patient queries combined with automated texts to enhance identification and
address participant unmet SDH needs (e.g., access to peer support, healthcare), and linkages and retention in
buprenorphine treatment per the medical management model (e.g., patient education, self-management). We
have also refined an evidence-supported Cultural Structural Humility (CSH) training for peer recovery coaches
(PRCs) that goes beyond a social determinants of health (SDH) framework to also include stigma reduction,
health habitus, and patient navigation to improve clinical outcomes and social services use among PWUO. This
proposal aims to adapt the evidence-supported CSH training to interactive video modules for peer recovery
coaches (PRCs), and refine an artificial intelligence (AI)-driven texting tool to reinforce core CSH principles. The
3-month pilot RCT will test AI-driven CSH-enhanced texting tool + CSH-trained PRC providing telephone-based
services coordination (multimodal intervention arm-1) vs. AI-driven CSH-enhanced texting tool (intervention
arm-2) vs. treatment as usual / informational pamphlets only (control arm) among emergency department-
enrolled Black / Latinx PWUO (N=150) to estimate rates of PRC-PWUO contact, AI-driven texting use among
PWUO, assess potential for pre-/post-intervention impact on reduction of felt and/or anticipated stigma, clinical
outcomes (i.e., time to initial receipt of buprenorphine), and social services use at 1- and 3-months to obtain
intervention effect sizes, and estimate the associated cost of implementing and sustaining the multimodal
intervention (e.g., cost-per OUD treatment days). The RE-AIM framework will inform implementation of this
multimodal intervention that has high public health impact on complementing the HHS Overdose Prevention
Strategy (i.e., harm reduction, OUD treatment, and recovery support) in a manner that is scalable, sustainable,
and equitable using open-source solutions. Our team is uniquely positioned to obtain data that will inform a
subsequent large-scale efficacy trial evaluating our proposed multimodal intervention to increase access to
buprenorphine and social services among Black / Latinx PWUO.
