NIH-Funded Community Partnership Study to Bring Lifesaving Care to Black Opioid Users

University of Miami Miller School of Medicine researchers will bring lifesaving medical care closer to Black residents with opioid use disorder in an innovative community partnership study.

The five-year, $14.2 million Better Together multisite clinical trial — part of the National Institutes of Health (NIH) Healing to End Addiction Long-term (HEAL) initiative — will use community organizations to reach the highly vulnerable population and provide buprenorphine, a medication shown to be effective for opioid dependence.

The Miller School will partner with the Jessie Trice Community Health Center in Liberty City to provide services and support for individuals with opioid use disorders.

“The Better Together study supports our longstanding commitment to provide high-quality care to Blacks, Hispanics and other underserved populations,” said Henri R. Ford, M.D., M.H.A., dean and chief academic officer of the Miller School. “This community partnership approach could become a model for reducing health disparities throughout South Florida.”

Reducing Drug Overdose Deaths

The Better Together trial will focus on reducing drug overdose deaths in Black communities with high levels of opioid use. In addition to the University of Miami, the NIH-funded study includes Howard University in Washington, D.C., and the University of Illinois Chicago.

A 2020 study by the U.S. Centers for Disease Control and Prevention (CDC) found that overdose death rates increased 44% for Black people in just one year. Most people who died by overdose had no evidence of treatment for substance use before their deaths, and a lower proportion of Black opioid user received treatment compared with their White counterparts.

Increasing access to proven treatment for all people who have substance use disorders is a critical part of their care and recovery, according to the CDC.

“This study provides an opportunity for researchers to think outside of the box to design a program in collaboration with persons who are experts on the African American community and the persons we will serve,” said study co-leader José Szapocznik, Ph.D., professor, public health sciences, architecture, psychology, and educational and psychological studies; chair emeritus, Department of Public Health Sciences; and founder and honorary director, Miami Clinical and Translational Science Institute. “It’s prioritizing the patients’ needs in a way that is community focused, not just research focused.

The study is funded by the NIH/National Institute on Drug Abuse (NIDA) through the 15-center National Drug Abuse Treatment Clinical Trials Network. Dr. Szapocznik is the managing principal investigator of the UM center and home of the Florida Node Alliance, which has attracted $100 million in NIH/NIDA funding in its 24-year history. The center is also the home of the Florida Node Alliance. Viviana Horigian, M.D., M.H.A., professor of public health sciences, serves as executive director of the Florida Node Alliance.

A Fresh Approach to Opioid Use Disorder

Participants in the Better Together trial will receive counseling and peer support at neighborhood locations supported by remote and local on-site prescriptions and management from community-based clinic providers. By shifting care for opioid use disorders from medical centers to community locations, the Better Together researchers expect multiple benefits for patients receiving treatment, including easier access to medication in a familiar environment with support from peer recovery support specialists.

“We’re using peers to help people feel more comfortable with the staff,” said Dr. Horigian, study investigator. “One of the things we know about opioid use disorders is that, because it is a stigmatized condition, it comes with a lot of shame. This program gives patients an opportunity to interact with a community setting where they will not feel stigmatized.”

To determine the effectiveness of this outreach approach, participants in the Better Together trial will be compared with a control group receiving buprenorphine and related support in a standard-of-care medical clinic environment. Researchers will examine medical outcomes, as well as retention and patient satisfaction.

“It is critical that persons who suffer from opioid use disorder stay on buprenorphine until they have made the profound personal and social changes that are needed to promote a drug-free lifestyle,” said Dr. Szapocznik. “Only then should these individuals stop taking the medication.”

Building Community Partnerships

In the first phase of the Better Together study, research teams in the three cities will form community advisory boards and select key community-based partner organizations and potential treatment sites within the priority neighborhoods.

“This is not a top-down project,” said Dr. Szapocznik, who said Miller School researchers will work closely with the Jessie Trice Community Health Center team. Other community stakeholders include churches serving Black congregations, the Miami-Dade County Homeless Trust, the Miami-Dade Police Department and grassroots community organizations.

“We are excited to be part of this study, which offers a paradigm shift for providing health care to our community,” said Timothy Tyler, Ed.D., director of outpatient behavioral services at Jessie Trice Community Health Center, and director of community programs for the Better Together trial. “The program addresses significant barriers to reaching these at-risk patients and enrolling them in care. We must go where the need is greatest, address the stigma and remove as many barriers to treatment as possible.”

Dr. Tyler added that the Miller School brings powerful research tools to the initiative, including data collection and analysis to support evidence-based intervention programs.

“We are delighted that this partnership will bring new ways to serve our community,” he said.

Tags: Better Together, community health, Dean Henri Ford, Department of Public Health Sciences, Dr. José Szapocznik, Dr. Viviana Horigian, HEAL initiative, Jessie Trice Community Health Center, NIH funding, opioid use disorder, public health