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Reducing Overdose and Substance Use-related Stigma by Training Non-substance-using Friends and Family Members of People Who Use Opioids to Be Harm Reduction Champions

ConditionsOpioid Overdose PreventionPeople Who Use Opioids/People With Opioid Use Disorder (OUD)Reduction of Substance Use-related StigmaNon-substance-using People With a Friend or Family Member Who Uses OpioidsPeer Harm Reduction Support Champions
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorUniversity of Illinois at Chicago

About this trial

Fatal opioid overdoses are more frequent among populations with low access to harm reduction (HR) services and with high substance use-related stigma (which is a major barrier to accessing HR services). One such population is older adults who use drugs (PWUD) on the West side of Chicago. Over 34% of Chicago's opioid-related EMS responses in 2023 were located in communities on the West side, but older adults in these communities access HR services at low rates, likely due to stigma and other barriers. To help address these barriers and increase HR service access among this population, the proposed clinical trial will evaluate a novel intervention that will recruit non-substance-using friends and family members of people who use opioids and live on the West side of Chicago, educate them on HR tools and services, and train them to become peer HR support champions. They will be asked to recruit one friend or family member who uses opioids to the study, who will also be provided with an educational training on overdose risk reduction and available HR tools and services. The intervention will then facilitate a counselor-led initial conversation between peer HR support champions and their friend or family member who uses opioids to help establish HR support, and provide all participants with naloxone and fentanyl test strip kits. This intervention will not only provide another mechanism through which PWUD can access HR tools and services, thereby reducing logistical barriers, but should also reduce stigma and increase social support by facilitating and normalizing open conversations about HR between PWUD and their non-PWUD HR support champions. Participants of a previous focus group conducted by the Investigators among West side PWUD thought this intervention would be helpful, said they would be willing to participate in it, and said they knew someone who could participate as their non-PWUD peer HR support champion. To facilitate recruitment of older adults, the Investigative Team will work with local faith-based and service organizations and educate them about the importance of HR. The intervention's efficacy will be evaluated for a) increasing uptake/use of HR services, b) decreasing overdose frequency, and c) decreasing stigma and other barriers to accessing HR services, both i) by examining change over time among intervention participants, and ii) by using propensity-score matching methods to compare outcomes between intervention participants and a comparison group of PWUD who have recently accessed HR services from one of the study's community partners (Community Outreach Intervention Projects or West Side Heroin and Opioid Task Force).

Eligibility criteria

This trial accepts healthy volunteers

Qualifiers

None

Disqualifiers

None

Trial design

Design model

Parallel

Treatments tested in this trial

  • Peer Harm Reduction Support Champion Intervention

    Behavioral

    This intervention will recruit non-substance-using friends and family members of people who use opioids and live on the West side of Chicago, educate them on harm reduction (HR) tools and services, and train them to become peer HR support champions. They will be asked to recruit one friend or family member who uses opioids to the study, who will also be provided with an educational training on overdose risk reduction and available HR tools and services. The intervention will then facilitate a counselor-led initial conversation between peer HR support champions and their friend or family member who uses opioids, to help establish HR-related support, and will provide all participants with naloxone and fentanyl test strip kits. This intervention will not only provide another mechanism through which people who use opioids can access HR tools and services, thereby reducing logistical barriers to access and preventing overdose, but it should also reduce stigma and increase social support.

Treatment groups

600 Participants
are divided into 2 treatment groups
Group A: Peer Harm Reduction Support Champion InterventionActive comparator 1 intervention
Group B: Non-equivalent comparison group of PWUD with some recent access to harm reduction servicesNo intervention 0 interventions

Trial outcomes

Primary outcomes

1

Overdose Frequency and Experiences

Overdose frequency and experiences will be measured using participant self-report on items used by the Investigators in previous studies of PWUD. Items will ask about the number of overdoses participants experienced in the last three months (at baseline) and since the last interview (for follow-up). For each overdose reported, items will ask whether the participant was alone, whether naloxone was used, whether first responders were called, and whether an emergency room visit occurred. Participants will also be asked to report on whether they were present while someone else overdosed, and if so, whether they or someone else used naloxone.

Time frame
baseline, 1 month, 3 months, 6 months
2

Number of Types of Harm Reduction Services Accessed

This will be measured using participant self-report. Participants will be asked about their harm reduction service access and use in the last three months (at baseline) and since the last interview (for follow-up). Specifically, participants will be asked to report on how many times they accessed or received naloxone and fentanyl test strip kits, used fentanyl test strip kits, used "never use alone" hotlines, used "safe spaces" to use drugs or to experience withdrawal, used syringe service programs, tested for HIV or HCV, accessed medication for opioid use disorder, and accessed other types of drug treatment. A composite score will be computed reflecting the number of types of harm reduction tools and services accessed, which will be a count of all service/tool types accessed or used.

Time frame
baseline, 1 month, 3 months, 6 months
3

Frequency of Access to Harm Reduction Tools and Services

This will be measured using participant self-report. Participants will be asked about their harm reduction service access and use in the last three months (at baseline) and since the last interview (for follow-up). Specifically, participants will be asked to report on how many times they accessed or received naloxone and fentanyl test strip kits, used fentanyl test strip kits, used "never use alone" hotlines, used "safe spaces" to use drugs or to experience withdrawal, used syringe service programs, tested for HIV or HCV, accessed medication for opioid use disorder, and accessed other types of drug treatment. A composite score will be computed reflecting frequency of access to these tools and services, which will be a sum of the total number of times each participant used any of the harm reduction tools and services above.

Time frame
baseline, 1 month, 3 months, 6 months

Secondary outcomes

1

Barriers to Harm Reduction Services (Number of Types of Barriers)

Barriers to harm reduction services will be measured using participant self-report on items used by the Investigators in previous studies of PWUD. Participants will be asked how many times they have wanted to access harm reduction tools or services but were not able to do so, which tools or services they were unable to access, and what prevented them from accessing them. Specifically, participants will be asked about naloxone and fentanyl test strip unavailability, transportation barriers, time of day/scheduling challenges (i.e., services were not available or open at the specific time of day/day of week needed), and whether anticipated stigma/fear of stigma was a barrier to seeking/obtaining services or tools. The total number of types of barriers experienced for each participant will be computed.

Time frame
baseline, 1 month, 3 months, 6 months
2

Barriers to Harm Reduction Services (Frequency of Experiencing Barriers)

Barriers to harm reduction services will be measured using participant self-report on items used by the Investigators in previous studies of PWUD. Participants will be asked how many times they have wanted to access harm reduction tools or services but were not able to do so, which tools or services they were unable to access, and what prevented them from accessing them. Specifically, participants will be asked about naloxone and fentanyl test strip unavailability, transportation barriers, time of day/scheduling challenges (i.e., services were not available or open at the specific time of day/day of week needed), and whether anticipated stigma/fear of stigma was a barrier to seeking/obtaining services or tools. The sum of the number of times participants experienced any of the barriers above will be computed.

Time frame
baseline, 1 month, 3 months, 6 months
3

Substance Use-related Stigma (Individual Experiences of Stigma)

Participants' experiences of substance use-related stigma will be measured using the Substance Use Stigma Mechanisms Scale (SU-SMS).

Time frame
baseline, 1 month, 3 months, 6 months
4

Substance Use-related Stigma (Perception of Community-Level Stigma)

Perceptions of substance use-related stigma in participants' communities will be measured by adapting a 7-item measure developed by PI Williams and the SIZE research team such that it will ask how likely respondents think people who use drugs are to experience stigmatizing behavior from people in their community.

Time frame
baseline, 1 month, 3 months, 6 months

Other outcomes

Sponsors and contacts

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University of Illinois at Chicago

Lead sponsor

Source ClinicalTrials.gov
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