Abstract
BackgroundNonmedical use of prescription opioids (defined as taking opioid medications for hedonic effects or in a manner other than prescribed) and the use of heroin have emerged in recent years as major public health concerns in the United States. Of particular concern is the prevalence of opioid use among emerging adults (ages 18–25), as this is a developmental period of heightened vulnerability and critical social, neurological, and psychological development. Data from 2015 show that American Indian/Alaska Native (AI/AN) people have the highest rates of diagnosis for opioid use disorders (OUDs). One recent study found that the overdose death rate among urban-dwelling AI/AN individuals was 1.4 times higher compared to those living in rural areas. To date, there are no evidence-based prevention programs addressing opioid use among urban AI/AN emerging adults that integrate culturally-appropriate strategies with evidence-based treatment. Traditions and Connections for Urban Native Americans (TACUNA) builds on our prior work with AI/AN communities across California to develop and evaluate culturally appropriate programming to address opioid, alcohol, and cannabis use among urban AI/AN emerging adults.Methods/designIn a randomized controlled trial, 18–25 year old urban AI/AN emerging adults will receive either TACUNA (n = 185), which comprises three virtual workshops utilizing motivational interviewing, social network visualization, and integrating traditional practices and a wellness circle, or one virtual culturally sensitive opioid education workshop (n = 185). We will evaluate intervention effects on primary outcomes of frequency of opioid, alcohol, and cannabis use, as well as secondary outcomes of social network characteristics and cultural connectedness, over a 12-month period.DiscussionThis project has the potential to expand the range and effectiveness of opioid, alcohol, and cannabis services for urban AI/AN emerging adults by addressing the opioid epidemic and use of other substances at both the community and individual level. In addition, it provides important culturally grounded conceptual and practical information to advance the field of substance use interventions and enhance resiliency among this population.Trial registration: ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020 https://clinicaltrials.gov/ct2/show/record/NCT04617938.
Highlights
Nonmedical use of prescription opioids and the use of heroin have emerged in recent years as major public health concerns in the United States
Facilitation of workshops Traditions and Connections for Urban Native Americans (TACUNA) workshops are designed to be facilitated by Native American individuals who have strong cultural knowledge, have received training on both the curriculum and the use of motivational interviewing, and have demonstrated proficiency in delivering the workshop material
Our programs focus on both prevention and intervention, and our target population is likely lower-risk in terms of these outcomes. This is unlikely to substantively influence our within-trial economic evaluation, it may have implications for longer-term budget impact analyses. This is the first study to date to address opioid use among urban American Indian/Alaska Native (AI/AN) emerging adults by testing a brief group Motivational Interviewing (MI) intervention that integrates traditional practices and social network visualization
Summary
The TACUNA intervention involves workshops at the individual level, a wellness circle at the community level, and is designed to reduce opioid, alcohol, and cannabis use, increase cultural connectedness, and encourage healthy social networks among urban AI/AN emerging adults. This clinical trial will compare the effectiveness of the TACUNA intervention to a culturally sensitive opioid education workshop, and examine outcomes over a 12-month period. The current study will be able to address important questions about the protective role of social networks for urban AI/AN emerging adults that have not been previously examined, providing an understanding of the amount of support these emerging adults receive to engage in traditional practices and make healthy choices around substance use. Abbreviations AOD : Alcohol and other drugs; AI/AN: American Indian/Alaska Native; HEAL: Helping to End Addiction Long-term; ICER: Incremental cost-effectiveness ratio; IRINAH: Intervention Research to Improve Native American Health; MTF: Monitoring the Future; MI: Motivational interviewing; MICUNAY: Motivational Interviewing and Culture for Urban Native American Youth; MISN: Motivational interviewing social network; MOUD: Medications for opioid use disorder; OUD: Opioid use disorders; RCT: Randomized controlled trial; RFA: Request for applications; RODS: Rapid Opioid Dependence Screen; SAMHSA: Substance Abuse and Mental Health Services Administration; SPIWC: Sacred Path Indigenous Wellness Center; SPIRIT : Standard protocol items: recommendations for interventional trials; TACUNA: Traditions and Connections for Urban Native Americans; WC: Wellness circle; WLSMV: Weighted least square mean and variance
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