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Poster describing a study that examined type-specific medications for opioid use disorder (MOUD) awareness (i.e., heard of) and referral willingness among CBO providers and clients. The data was acquired via cross-sectional survey of 13 Southern U.S. CBOs in FL, GA, LA, MS, and TN. Analysis revealed that compared with methadone, buprenorphine and naltrexone awareness is lower for both providers and clients, though providers are more aware of all types of MOUD than clients. Additionally, providers report greater willingness to refer for buprenorphine and naltrexone than clients report willingness to be referred (especially for naltrexone).

This type of misalignment can hinder MOUD uptake, weaken provider-client linkage, and contribute to high overdose rates and limited provider and MOUD access in the South.

Related protocols: CTN-0082

The CTN Dissemination Library is a digital repository of resources created by and about NIDA’s National Drug Abuse Treatment Clinical Trials Network (CTN). It provides a single point of access to research findings and other materials approved for dissemination across the CTN and to the larger community of providers, researchers, policy-makers, and the public. By making research findings available in multiple formats, the Library helps bridge the gap between science and practice.

Starting in 2026, the CTN Library is expanding with two new services: 1) Hosting the NIDA CTN Common Data Elements (CDE) website; 2) Developing research dissemination materials in collaboration with study teams (including print materials, online trainings, videos, podcasts, digital toolkits, and more).

Read all about these new services in this poster presented at the 2026 CTN Annual Scientific & Steering Committee Meeting.

There is an urgent need within the substance-use-disorders (SUD) treatment field to develop and implement consensus-based common core data elements (CDEs) with standardized vocabularies relevant to drug addiction treatment that could be incorporated and widely adopted into harmonized electronic medical record systems (EMRs). This will benefit patients by improving the quality of care and will assist in integration of specialty addiction treatment into disciplines of mainstream medicine. To achieve these aims, the NIDA Clinical Trials Network (CTN) has collected and collated dozens of treatment-form-related information and standardized instruments to develop a treatment-relevant set of CDEs. These CDEs were refined following a consensus-based meeting of federal, state, and community-based treatment stakeholders and providers. This poster describes the collaborative “Mind Map” used for developing and implementing core questions as CDEs for EMRs on SUD in primary care and SUD specialty treatment settings. Current progress in developing EMR core questions as CDEs for use in those settings is also provided, as well as implications of this project for the future of drug abuse treatment. NIDA is especially interested in input from College on Problems of Drug Dependence (CPDD) members on data collection hierarchy and core data elements and on the overall strategy in regards to other sources of input, other stakeholders who should be consulted, and other “next steps” as this project moves forward.

This poster reports on an initiative to implement HIV rapid testing in substance abuse treatment programs in the state of South Carolina. A multi-agency collaboration between the Single State Authority, the state Health Department, the regional Addiction Technology Transfer Center (ATTC), and one substance abuse treatment program (Lexington-Richland Alcohol and Drug Abuse Council (LRADAC)), facilitated state-wide implementation. LRADAC, a community-based treatment program, was one of twelve sites that participated in the CTN trial on HIV rapid testing (protocol CTN-0032). Upon completion of the trial, LRADAC implemented a rapid HIV testing and counseling program as a clinical service. South Carolina’s previous efforts to implement on-site rapid HIV testing in 10 pilot agencies had less than optimal success due to the absence of a successful model on which agencies could base their implementation plan. With support from the collaborating agencies, staff developed and presented a 2 1/2 day HIV testing and counseling curriculum at the annual SC School of Alcohol and Drug Studies in 2010. Following the successful completion of the course, participants were fully certified to conduct testing and counseling in their local programs. Course participants had the opportunity to learn the counseling and testing procedures that LRADAC staff found successful in implementing their program. Although challenging, implementing HIV testing program in substance abuse treatment programs is feasible for agencies. The multi-agency collaboration in South Carolina supported the development of an HIV testing and counseling course that was team taught and showcased a successful model on which implementation could be based. Consequently, this effort increased the likelihood that additional substance abuse agencies within the state would move forward with implementation.

Related protocols: CTN-0032

The health services field is increasingly concerned about burnout and turnover among service providers. Substance abuse professionals are particularly susceptible to burnout since factors such as large caseloads, limited resources, low pay, and bureaucratic work environments contribute to burnout. In addition, substance abuse professionals work with a challenging client population of addicts and referrals from the criminal justice system which can leave them feeling frustrated, depressed, and helpless in assisting clients. Examining work environment factors that are amenable to change may make a difference in curbing burnout (and ultimately deterring turnover) among substance abuse counselors. Clinical supervision is one such factor, as it is the primary mechanism for on-the-job training and counselor development. Further, negative experiences in clinical supervision can contribute to burnout and ultimately turnover. As such, the authors propose that positive experiences with one’s clinical supervisor may reduce counselor burnout whereas negative experiences may actually exacerbate burnout. And consistent with previous research, burnout should predict counselor turnover intentions.

This poster describes the outcomes of a CTN platform study that surveyed 462 counselors employed at fifteen CTPs (community treatment programs) in the Clinical Trials Network. Two dimensions of burnout were examined: depersonalization and emotional exhaustion. The variables of role overload, job satisfaction, and pay satisfaction were used as control variables in all of the multiple regression analyses. The results indicate that both positive and negative clinical supervisory experiences are associated with turnover intentions. Likewise, counselor burnout was associated with turnover intentions. Further, both depersonalization and emotional exhaustion were partial mediators of the relationship between positive and negative clinical supervisory experiences and turnover intentions. This study indicates that high quality clinical supervision may be important in reducing burnout and subsequent counselor intentions to turnover. The practical suggestions include in-house and education-based training on effective clinical supervision and performance management systems that hold clinical supervisors accountable for their behavior toward counselors.

Although substance abuse treatment programs are an important point of contact to provide health services to diagnose, treat and prevent transmission of hepatitis B (HBV) and hepatitis C (HCV) viral infection, little is known about the availability of these services in substance abuse programs. This presentation reports on a study that evaluated the prevalence and spectrum of HBV and HCV services offered by drug treatment programs in the U.S. A questionnaire-based survey of drug treatment programs within the National Drug Abuse Treatment Clinical Trials Network was conducted as part of protocol CTN-0012 (“Characteristics of Screening, Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral Infections, and Sexually Transmitted Infections in Substance Abuse Treatment Programs”). Completed questionnaires were received from 269 (84.3%) of the 319 program administrators. Although 78.7% of programs reported that they offered ongoing hepatitis training for clinical staff, only a minority of programs offered testing for HBsAg (37.7%), HBsAb (36.7%), HBcAb (27.7%), HBV DNA (7.8%), HCV antibodies (52.9%), HCV qualitative (10.1%) or quantitative (8.9%) PCR, and HCV genotyping (11.6%). Hepatitis A and B vaccinations were offered by 68.3% of programs, either on site (19.3%) or via referral (49.1%). Programs having clear guidelines for hepatitis testing were significantly more likely to offer each of the hepatitis tests as compared with those that did not have clear guidelines. Only 28.9% of programs offered HCV treatment either on-site or via referral.

Despite the importance of substance abuse in sustaining the hepatitis epidemics in the U.S., many substance abuse treatment programs do not offer comprehensive HBV, HCV and hepatitis vaccination services. Public health interventions to improve access to hepatitis testing, treatment and prevention for substance abusers are needed.

This poster discusses the results of a survey done as part of protocol CTN-0012 (“Characteristics of Screening, Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral Infections, and Sexually Transmitted Infections in Substance Abuse Treatment Programs”), emphasizing the perspective of state substance abuse and health departments in relationship to the treatment programs within their jurisdiction for three infection groups: HIV/AIDS, Hepatitis C virus, and sexually transmitted infections. State substance abuse and health departments were compared regarding priorities, written guidelines and availability of funding for 8 selected services for the 3 infections (24 comparisons). In addition, clarity of guidelines and availability of funding for the 8 services, as reported by administrators and clinicians at treatment programs offering these services were compared with guidelines and funding as reported by the states. Surveys were received from 48 states and DC (96%) representing 46 substance abuse and 42 health departments. The response rate from treatment program administrators and clinicians was 269 (84%) and 1723 (78%), respectively. There was general agreement between states and the two departments within the states regarding priorities and availability of funding (19 of 24 comparisons). While most states had guidelines for infection-related services, clarity of guidelines as expressed by treatment program administrators and clinicians was less than optimal. For funding, treatment program administrators indicated less availability than the states for all 24 comparisons, 19 of which were statistically significant. While states appear generally to have their priorities, guidelines and funding in place, the mosaic that constitutes the healthcare delivery system may be too complex for the treatment programs to access most efficiently.

The Treatment Effectiveness Assessment (TEA) score is derived from a 4-item self-administered assessment utilizing a Likert scale to evaluate changes across four life domains: substance use, personal responsibilities, health, and citizenship. The World Health Organization Quality of Life Brief (WHOQOL-BREF) scale is a shortened version of the original instrument that may be more convenient for use in large research studies or clinical trials. It assesses the individual’s perceptions in the context of their culture and value systems, and their personal goals, standards, and concerns. Cocaine craving is a core symptom of cocaine use disorder and remains a consistent obstacle to achieving sustained reductions in use and relapse prevention.

This secondary analysis of data from CTN-0048 aimed to examine relationships between quality of life and health satisfaction (using the WHO-QOL scale), cocaine use (urine drug screens), and patient ratings of treatment effectiveness, as measured by the TEA over 8 weeks of treatment.

Results found significant negative relationships between cocaine craving and TEA and significant positive relationships between patient quality of life and satisfaction with health. A model including 4 health domains also indicated that there were significant positive relationships between health domains and TEA as well. TEA was not significantly related to longest duration of abstinence (LDA) for cocaine verified by urine drug screens.

Conclusions: Self-reported treatment effectiveness was integrally related to patient level factors, over time, while in treatment for cocaine use disorder and receiving placebo or buprenorphine and extended-release naltrexone, however TEA was not predictive of LDA. Recognizing and providing parallel intervention for these patient level factors during substance use disorder treatment may enhance patient reports of treatment effectiveness, indicating improvement across the patient reported domains of substance use, life satisfaction, health, and community.

Related protocols: CTN-0048

Cocaine craving is a core symptom of cocaine use disorder (CUD) and remains a consistent obstacle to achieving sustained reductions in use and relapse prevention. A systematic review examining pharmacological treatment for cocaine craving reported that in their review of 130 clinical trials, there was an association between craving and multiple cocaine use outcomes in most studies, including both self-report and biochemical evidence of use (i.e., urinary benzoylecgonine). Some studies have examined relationships between craving and treatment efficacy with opioid agonists and shown more mixed results.

This study aimed to examine the relationship between self-reported cocaine craving over time (i.e., 100mm Visual Analog Scale) and cocaine use over time (measured via urine drug screen and self-report) in a sample of patients receiving medication treatment for cocaine use disorder (from CTN-0148).

Results from the urine drug screen model found that there was a significant relationship between cocaine craving and urine drug screens for cocaine use (OR=0.98, p<0.01), such that lower cocaine craving was associated with higher percentages of negative urine drug screens, while holding treatment assignment constant. Results from the self-reported use model found that there was a significant impact of time on self-reported cocaine use, and when examining the time by craving interaction (B=0.0008, p<0.01), such that lower cocaine craving was associated with higher percentages of negative self-reported cocaine use, while holding treatment assignment constant.

Conclusions: Low craving is significantly associated with decreased cocaine use over time while receiving placebo or buprenorphine and extended-release naltrexone. This therapeutic may represent a promising treatment to build on for the medical treatment for cocaine use disorder.

Related protocols: CTN-0148

American Indian and Alaska Native (AI/AN) communities experienced a disproportionate increase in opioid-related poisonings during COVID-19. Availability of treatment, such as medications for opioid use disorder (MOUD) within AI/AN communities, is therefore imperative. We completed qualitative interviews with substance use disorder treatment providers providing services to AI/AN adults to assess the impact of COVID-19 related regulatory changes (e.g., medication dosing) and transitions in services (i.e., telemedicine) that aimed to enhance access to care. This project was supported by CTN-0118.

Related protocols: CTN-0118

Opioid use disorder (OUD) represents a significant public health challenge. Identifying variations in the severity of opioid withdrawal that can predict treatment success and may help improve the process of aligning patients with appropriate therapies could help improve outcomes. This study was a secondary latent class growth analysis (LCGA) of data from a randomized controlled trial that involved individuals seeking treatment for OUD (CTN-0051). Participants were 474 adults (270 taking buprenorphine, 204 on extended-release naltrexone (XR-NTX)) in a 24-week trial for OUD. Withdrawal was measured weekly using the Subjective Opioid Withdrawal Scale. Analysis found that a two-class model (high sustained withdrawal and low withdrawal classes) was most parsimonious among patients in both treatment arms. The experience of withdrawal was more intense in the high withdrawal class of the BUP arm when compared to the XTR arm (average M=22.9 vs. M=12.4 respectively). No differences were evident regarding age, sex, race, or ethnicity. There were significant differences in history of anxiety and history of depression.

Related protocols: CTN-0051

In the United States, one in 14 individuals experience a Substance Use Disorder (SUD). SAMHSA stated that in 2020, approximately 40 million individuals from ages 12 and above had a SUD (CDC, 2022 ; SAMHSA, 2021). There has been a 44% increase in overdose rates in Black communities between 1999 to 2023. One longitudinal study found that the opioid overdose fatality rate among “non-Hispanic Black men 55 years or older was 40.03 per 100,000 population, 4 times greater than the overall opioid overdose fatality rate of 10.70 per 100,000 for persons of the same age” (Mason, Soliman, Kim, & Post, 2022).

This poster describes CTN-0127, a pilot exploratory study that will pave the way for future initiatives focused on increasing SUD care in underserved Black communities through learning collaboratives (LC) between faith-based leaders (FBLs) and behavioral health providers (BHLs). An LC is a short-term (6- to 15-month) learning system that brings together teams (e.g., FBLs, community members, behavioral health/SUD, and social service providers) to seek improvement in a focused topic area.

Related protocols: CTN-0027

This ancillary investigation of data from NIDA Clinical Trials Network protocol CTN-0051, a randomized, controlled trial comparing extended-release naltrexone to buprenorphine, examined baseline sex differences in men and women (N=570) with opioid use disorder (OUD) receiving inpatient services. Women were significantly younger; more likely to identify as bisexual, live with a sexual partner, and be financially dependent on someone else; and less likely to be employed. Women reported significantly greater psychiatric comorbidity and risk behaviors, and had shorter duration, but similar age of onset, of opioid use.

Conclusions: Findings underscore economic, psychiatric, and infection vulnerability among women with OUD, which may complicate treatment initiation, retention, and recovery. Interventions targeting these disparities should be explored.

Related protocols: CTN-0051

This study describes the approach and results of a comprehensive cost analysis of NIDA Clinical Trials Network protocol CTN-0051, Extended-Release Naltrexone vs. Buprenorphine for Opioid Treatment (X:BOT), the first head-to-head randomized clinical trial in the U.S. of extended-release injectable naltrexone (XR-NTX) and buprenorphine-naloxone (BUP-NX) for preventing opioid relapse. The objective was to provide rigorous estimates of the costs of training, inpatient detoxification, and medication management visits, highlighting the variation in these costs across sites and settings. Results found that providing XR-NTX and BUP-NX to patients receiving inpatient detoxification generates relatively modest costs to the healthcare provider. The average costs per patient were $5,416 for XR-NTX and $4,148 for BUP-NX. Results of the X:BOT cost analysis study provide current practical information on the types of costs incurred by providers, payers, and patients for XR-NTX and BUP-NX, but continued research is needed to understand the costs of medication-assisted treatment as the system continues to evolve.

Extended-release naltrexone (XR-NTX), an opioid antagonist, and buprenorphine-naloxone (BUP-NX), a partial opioid agonist, are pharmacologically and conceptually distinct opioid relapse prevention interventions. This study aimed to estimate the difference in opioid relapse-free survival between XR-NTX and BUP-NX. This NIDA Clinical Trials Network protocol, CTN-0051, was initiated at 8 community-based inpatient programs, and followed participants as outpatients for 24 weeks. The primary outcome was opioid relapse-free survival (where relapse was defined as 4 consecutive weeks of non-study opioid use by urine toxicology or self-report, or 7 consecutive days by self-report).

Results found that, as expected, XR-NTX had a substantial induction hurdle — fewer initiated XR-NTX (72%) than BUP-NX (94%). Among the intention-to-treat (ITT) population (n=570), 24-week relapse events were greater for XR-NTX (65%) than for BUP-NX (57%). Most of this difference is accounted for by early relapse in nearly all (89%) XR-NTX induction failures. Among participants successfully inducted (n=474), 24-week relapse events were similar across arms. Opioid-negative urines and opioid-abstinent days favored BUP-NX among the ITT population, but were similar across arms among the per-protocol population. Opioid craving was initially less with XR-NTX than with BUP-NX, converging by week 24. Except for XR-NTX injection site reactions, treatment-emergent adverse events did not differ between treatment groups. Five fatal overdoses occurred (2 in the XR-NTX group, 3 in the BUP-NX group).

Conclusions: In these settings, it was more difficult for participants to initiate XR-NTX, and nearly all of those who failed induction quickly relapsed. Better overall opioid outcomes for the BUP-NX group in the intention-to-treat population were directly related to differential induction failure. No differences were found between the two groups for adverse events, serious adverse events, overdoses, and fatal overdoses. Future work should focus on facilitating induction to XR-NTX and on improving treatment retention on both medications.