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Background: Cannabis is the most commonly used drug in the United States, and among people who use cannabis, polysubstance use is common and understudied. We aimed to examine the association of tetrahydrocannabinol (THC) positive urine drug screen (+UDS) with the odds of submitting a cocaine + UDS during cocaine use disorder treatment.

Methods: We conducted a secondary data analysis of a previously reported double-blind, placebo-controlled clinical trial, CTN0048. Participants meeting criteria for opioid abuse/dependence were assigned to receive extended-release naltrexone and one of three conditions of buprenorphine (placebo, 4 mg/day, 16 mg/day) for 8 weeks. Generalized estimating equations (GEE) were used to analyze urine samples (Liu et al., 2018) collected over time, examining the association between THC + UDS and cocaine + UDS during treatment.

Results: Participants (n = 301) averaged 46 (SD = 8.64) years of age, were majority male (78.41 %), non-Hispanic (89.70 %), and African American (66.45 %). GEE results indicated that patients who submitted THC + UDS had significantly higher odds of submitting cocaine + UDS compared to participants who submitted THC-negative UDS across the 25 time points examined (OR = 1.47, 95 % CI = 1.21–1.79, p = 0.00). Time (OR = 0.9998, 95 % CI: 0.9997, 0.9999, p = 0.018) and the covariate of sex assigned at birth (OR = 1.77, 95 % CI = 1.13–2.77, p = 0.013) were also significant in the model, indicating very small decreases in the odds of submitting a cocaine + UDS over time for all patients and 77 % higher odds of submitting cocaine + UDS for females.

Conclusion: THC + UDS was associated with increased odds of submitting a cocaine + UDS during treatment. Further investigation is needed to discern whether decreasing THC use will result in reduced cocaine use; however, these results suggest that it may be beneficial to counsel patients on cannabis use cessation both before and during treatment for cocaine use, as it is related to cocaine use treatment outcomes.

Related protocols: CTN-0048

Background: This study examined sexual delay discounting (SDD) as a potential factor associated with the relationship between substance use and condomless anal sex (CAS) among Black and Latino men who have sex with men (MSM).

Methods: Baseline data were drawn from a multi-site HIV testing promotion trial (NIDA-CTN-0083) involving Black and Latino MSM across eight U.S. states and the District of Columbia. Past 90-day CAS and past 12-month substance use were assessed via self-report. SDD was measured using the Sexual Delay Discounting Task and summarized as area under the curve (AUC) values. K-means clustering identified four SDD profiles: high self-control, globally impulsive, immediate-impulsive, and delayed-impulsive. Ordinal logistic regression models examined associations among substance use, SDD profiles, and CAS.

Results: A total of 271 participants were included. Compared with the high self-control group, the odds of CAS were significantly higher among the delayed-impulsive (OR = 2.978, p = 0.001), immediate-impulsive (OR = 8.970, p < 0.001), and globally high-discounting groups (OR = 9.427, p < 0.001). Alcohol and illicit drug use were modeled separately. Although substance use showed no overall main effect, significant interactions indicated that illicit drug use was more strongly associated with CAS among immediate-impulsive (OR = 1.485, p = 0.039) and globally high-discounting participants (OR = 1.686, p = 0.004).

Conclusions: SDD profiles were associated with CAS and may shape how illicit drug use relates to sexual risk behavior among Black and Latino MSM. These findings highlight the importance of considering temporal impulsivity in HIV prevention efforts.

Related protocols: CTN-0083

Aims: This study, supported by the CTN Ohio Valley Node, aimed to identify substance use disorder (SUD) patterns and their association with T2DM health outcomes among patients with type 2 diabetes and hypertension.

Methods: Researchers used latent class analysis on electronic health records from the MetroHealth System (Cleveland, Ohio) to obtain the target SUD groups: i) only tobacco (TUD), ii) tobacco and alcohol (TAUD), and iii) tobacco, alcohol, and at least one more substance (PSUD). A matching program with Mahalanobis distance within propensity score calipers created the matched control groups: no SUD (NSUD) for TUD and TUD for the other two SUD groups. The numbers of participants for the target-control groups were 8009 (TUD), 1672 (TAUD), and 642 (PSUD).

Results: TUD was significantly associated with T2DM complications. Compared to TUD, the TAUD group showed a significantly higher likelihood for all-cause mortality (adjusted odds ratio (aOR) = 1.46) but not for any of the T2DM complications. Compared to TUD, the PSUD group experienced a significantly higher risk for cerebrovascular accident (CVA) (aOR = 2.19), diabetic neuropathy (aOR = 1.76), myocardial infarction (MI) (aOR = 1.76), and all-cause mortality (aOR = 1.66).

Conclusions: The findings of increased risk associated with PSUDs may provide insights for better management of patients with T2DM and hypertension co-occurrence.

Aims: This study aimed to examine within and between effects of the relationship between depression, using the Beck Depression Inventory (BDI), and cocaine craving, using the visual analog craving scale (VAS), over time.

Methods: Data from the NIDA Clinical Trial Network Study Cocaine Use Reduction with Buprenorphine (CTN-0048) were used in a secondary analysis (CTN-0148). Random-effects regression modelling was used to examine relationships between participants’ depressive symptoms and their cocaine craving over time.

Results: A total of 301 participants with past-year DSM-IV criteria for cocaine and opioid use disorder were analyzed (21.6% female, 10.3% Hispanic, 66.4% Black) being treated with placebo or buprenorphine+naloxone. Craving significantly decreased over time (B = −1.11, 95% CI [-1.21, −1.02], p < 0.001). Depression emerged as a significant within-person predictor of craving over time (B = 0.93, 95% CI [0.76, 1.09], p<0.001), indicating that when a person’s BDI score increased by one point from their own mean, their craving increased by 0.71 units. Between-person differences in average BDI did not have significant effects (p>0.05), indicating that depression scores across participants did not significantly predict differences in craving.

Conclusions: These findings highlight depression as a dynamic, time-varying clinical marker of heightened craving risk and suggest that monitoring and addressing increases in depressive symptoms during treatment may help mitigate craving spikes and potentially reduce vulnerability in returning to use.

Related protocols: CTN-0148

Background: While medication for opioid use disorder (MOUD) is effective for a significant proportion of patients, many return to using opioids during treatment. Understanding which factors lead to successful treatment informs the development of implementation approaches that can improve outcomes. This manuscript and its accompanying website provide an applied introduction to interpretable machine learning for clinical investigators interested in predicting treatment response for people using MOUD.

Methods: This study, which uses data from CTN-0094, applied machine learning (ML) algorithms (K-Nearest Neighbors (KNN), logistic regression with and without regularization, Multivariate Additive Regression Splines (MARS), Support Vector Machines, Classification and Regression Trees (CART), Random Forest, Bayesian Additive Regression Trees (BART), Boosted Trees, Neural Networks) to predict failure of treatment in a collection of 2478 individuals who had participated in the three largest pragmatic, clinical trials of MOUD.

Results: All models produced Receiver Operating Characteristic Area Under the Curve (ROC AUC) estimates in the range of 0.62 to 0.67 using cross-validation data and the optimal model, random forest, achieved 0.65 using testing data. The algorithms nearly universally identified predictive features such as age, intravenous drug use days, study medication, and study site. Most algorithms also identified various aspects of smoking. Only the algorithms that detect complex non-linear trends identified details from timeline follow-back. One algorithm, BART, performed well while devaluing all treatment-specific details.

Conclusions: After explaining how to apply, compare, and contrast various ML workflows, the results show that while overall modeling performance is similar across the models developed, the use of different algorithms identifies different sets of predictive features. Previous research has not recognized some features as important for predicting treatment outcomes. A companion website introduces clinical investigators to the concepts and implementations this study presents. That site also provides a detailed annotated blueprint to fully replicate, or even expand, this work.

Related protocols: CTN-0094

Cocaine use disorder (CUD) is a major public health issue, and greater cocaine use severity has been associated with worse treatment retention and outcomes. Therefore, greater understanding of processes that influence cocaine use is needed. Both anhedonia (i.e., undervaluation of nondrug rewards) and cocaine demand (i.e., cocaine valuation) are related to cocaine use severity and thematically related to each other at face value, but no studies have directly compared these outcomes to our knowledge.

The present study represents a secondary analysis from a two-phase sequential, multiple assignment, randomized trial aimed at developing adaptive interventions for CUD (CTN-0130). We examined the relationship between anhedonia and cocaine demand and how these measures were related to cocaine use severity. Participants (N = 116) were treatment-seeking adults with CUD. All measures were taken at baseline before treatment initiation. Analyses revealed (a) moderate and very strong evidence of relationships between cocaine demand factors (i.e., persistence, amplitude) and anhedonia (PP values ≥ 77.8%); (b) positive association between cocaine demand (both persistence and amplitude) and measures of cocaine use severity, with the exception of one relationship, which was in the opposite direction; and (c) demand amplitude continued to be positively related to cocaine use severity, even when considering anhedonia.

Conclusions: Overall, findings from this study indicate cocaine demand relates to cocaine use severity more strongly than anhedonia.

Related protocols: CTN-0130

Introduction: Despite rising concern about overdoses from fentanyl-adulterated cocaine, research on responses to adulteration among people who use cocaine (PWUC) is limited. We aimed to identify what risk mitigation strategies PWUC would engage in if they suspected fentanyl in their cocaine. Secondarily, we tested whether key individual differences were related to use of risk mitigation strategies.

Methods: A secondary analysis of an online study (CTN Protocol ID: CTN-0130) collected responses from 97 self-reported cocaine purchasers. Participants completed questionnaires on demographics and substance use and reported what they would do if they found out their cocaine might contain fentanyl. Participants selected from a list of behaviors (with a free response option). Responses were coded into a four-level variable: “no change,” “transfer risk,” “harm reduction,” and “abstain.”

Results: About 16.5% endorsed no change in their behavior, 14.4% endorsed transfer risk, 25.8% endorsed harm reduction, and 43.3% endorsed abstain. Of the 10 individual differences tested only cocaine use frequency and previous personal experience of overdose significantly related to selected behaviors. Further analysis showed those with more frequent cocaine use, or prior overdose experience were more likely to use cocaine normally or transfer risk rather than use harm reduction or abstain.

Conclusion: While 83.5% of our sample reported they would attempt to mitigate risk if they suspected fentanyl in their cocaine, participants with more frequent cocaine use or a prior overdose endorsed less use of typical harm reduction or abstention. This highlights the need to direct harm reduction interventions to PWUC to mitigate the fentanyl overdose risks.

Related protocols: CTN-0130

Purpose: Emergency Departments (ED) are important settings for initiating care following a non-fatal opioid overdose (NFOO). While ED-based interventions, including peer-led recovery support and initiation of medications for opioid use disorder (MOUD), are promising methods for reducing subsequent overdoses and mortality, randomized trials of ED-based overdose prevention or treatment- linkage interventions demonstrate that a substantial proportion of patients decline participation. The current secondary analysis is designed to characterize individuals who declined to participate in one such study.

Methods: Data were used from the Peer Intervention to Link Overdose Survivors to Treatment (PILOT) trial (CTN-0107), which was a multi-site study conducted in three US-based EDs that randomized participants to a 6-month peer-led overdose prevention intervention or treatment as usual in the ED. Demographics and clinical characteristics of those enrolled in PILOT (n = 150) were compared to those who declined to participate but completed a screening exit survey (ScrES; n = 46).

Results: Among those who declined study participation, 76% had experienced a prior overdose preceding the current overdose that brought them into the ED (58.7% within the past 72 h), 56.5% were not currently engaged in substance use treatment and among those, 65.4% expressed a desire for treatment. Odds of declining study participation decreased with age by 6% per year (OR = 0.94, 95% CI: 0.9, 0.99); those with any college experience had odds of declining at 3 times greater than those without a high school diploma (OR = 3.4, 95% CI: 1.2, 10.1). Those without health insurance had odds of declining nearly 3 times those with insurance (OR = 2.9, 95% CI: 1.2, 7.0). Frequently cited reasons for declining were a desire to leave the ED or feeling unwell (39.1%), lack of interest in research (30.4%) and a belief the intervention would not be helpful (17.4%).

Conclusions: Results from this analysis characterize ED patients declining to participate in peer-led overdose prevention research with the goals of enhancing future recruitment strategies and enrolling more representative samples to reduce subsequent overdoses. Future work is needed to determine how to better engage priority populations at critical touch points, while ensuring that interventions are flexible, patient-centered, and potentially offer remote access.

Related protocols: CTN-0107

Objectives: To identify and value resources required to implement and sustain the Massachusetts model of office-based addiction treatment (MA Model) in the Primary Care Opioid Use Disorders Treatment trial (NCT03407638) using a nurse care manager (NCM) to support medication for opioid use disorder in primary care settings.

Study design: A site-specific microcosting analysis was conducted via activity-based costing. Guided by a structured costing instrument, we conducted semistructured interviews with relevant personnel and assigned nationally representative costs.

Methods: Data came from 6 health care systems. Costs were categorized as fixed start-up, time dependent, or variable and estimated as annual per-clinic and per-patient costs for implementation and sustainment phases.

Results: Mean implementation cost (ie, year 1 fixed start-up, time-dependent, and variable) was $238,888 per clinic ($3185 per patient); each subsequent year cost $229,676 ($3062 per patient), assuming 75 patients per month and 29% new patient case mix. Mean onetime fixed start-up costs were $9212 per clinic and included supplies and training. Time-dependent costs were $70,446 per clinic and included rent and meetings. Variable costs were $159,229 per clinic and included NCMs’ and prescribers’ clinical duties. On average, NCMs spent 1967.6 hours on MA Model-related work per year (26.2 hours per patient). In sensitivity analyses, costs varied drastically with patient caseload, provider mix, and new patient case mix.

Conclusions: Fixed start-up and time-dependent costs were minimal. Variable costs were 66.7% of implementation costs and 69.3% of costs annually afterward. The primary cost driver was NCM time conducting MA Model-related work. The additional value of the model will depend on associated downstream outcomes. These results may be helpful to health care systems considering implementing the MA Model.

Related protocols: CTN-0074

This is the primary outcomes article for CTN-0080-A-2. Introduction: Racial and ethnic inequities persist in medication treatment initiation and adherence for pregnant and postpartum people with opioid use disorder (OUD). Our objective was to understand the experiences of “positive outliers,” specifically pregnant and postpartum people of color with OUD who utilized medication treatment and engaged in a randomized clinical trial for buprenorphine despite historical, cultural, and structural barriers.

Methods: We conducted two sets of semi-structured qualitative interviews. First, trained peers with lived expertise as mothers in recovery interviewed individuals who identified with a non-white race and/or ethnicity and enrolled in the Medication Treatment for OUD in Expectant Mothers (MOMs) trial (NCT03918850). Second, we interviewed principal investigators, clinicians, and research coordinators from the 13 MOMs trial sites. We used an inductive thematic approach informed by the Social Ecological Model of Racism and Anti-Racism. Transcripts were double-coded and reviewed until consensus was reached. Preliminary findings from participant and staff interviews were merged and triangulated with peers to inform theme development.

Results: We completed 17 interviews with MOMs trial participants from 7 sites. Participants identified as Hispanic (29%), Black non-Hispanic (24%), multi-racial Hispanic (18%), multi-racial non-Hispanic (18%), and American Indian, Native Hawaiian, or Pacific Islander (12%). Thirty-two interviews with trial staff were also completed. Three themes emerged: (1) Although some participants expected racist treatment and research exploitation, all participants interviewed reported non-discriminatory, non-judgmental care within the MOMs trial; (2) Compassionate care, frequent, personalized, and integrated encounters, and emotional support helped counteract prior stigmatizing and discriminatory health care interactions, enabling participants of color to feel particularly supported, trusted, and empowered during the MOMs trial; and (3) Despite pervasive cultural stigma around addiction and concerns about taking an investigational drug while pregnant, participants expressed that pregnancy status, care team trust, and transparent communication with MOMs trial staff encouraged medication utilization and adherence.

Conclusion: Facilitators of successful engagement in the MOMs trial and retention in medication treatment among pregnant and postpartum people of color with OUD included non-judgmental care, sustained trust, and frequent contact. Key perinatal OUD clinical interventions and trial improvements include personalized communication and scheduling flexibility to promote engagement of marginalized populations.

Related protocols: CTN-0080-A-2

Importance: Health plan disenrollment may interrupt treatment for opioid use disorder (OUD) and overall care, increasing risk for serious outcomes, including overdose and death. There is limited evidence on the association of disenrollment with all-cause and overdose mortality after initiating medications for OUD (MOUD) treatment.

Objective: To assess the association of health plan disenrollment with all-cause and overdose mortality in patients treated with MOUD.

Design, setting, and participants: This cohort study conducted by the CTN Health Systems Node, included privately and publicly insured patients aged 16 years or older who initiated buprenorphine or naltrexone for OUD treatment between January 1, 2012, and December 31, 2021, at 3 integrated health insurance and care delivery systems in 2 US states. Patients were followed up to 2 years until December 31, 2022. Data were analyzed July 2024 to November 2025.

Exposure: Health plan disenrollment following MOUD initiation.

Main outcomes and measures: All-cause mortality and drug-related and alcohol-related overdose mortality within 2 years of MOUD initiation ascertained from the National Death Index. Survival analyses were adjusted for patient sociodemographic and clinical characteristics.

Results: Among 20,011 patients (mean [SD] age 38.7 [15.1] years; 12 299 males [61.5%]) who were treated for OUD, 6948 (34.7%) experienced disenrollment and 586 (2.9%) died during follow-up. The crude rate was 15.3 (95% CI, 14.1-16.6) per 1000 person-years for all-cause mortality and 6.2 (95% CI, 5.4-7.0) per 1000 person-years for overdose mortality. Ever experiencing disenrollment showed elevated all-cause mortality (17.6 [95% CI, 14.9-20.8] vs 14.7 [95% CI, 13.4-16.1] per 1000 person-years) and overdose mortality (8.9 [95% CI, 7.1-11.3] vs 5.4 [95% CI, 4.7-6.3] per 1000 person-years) relative to remaining enrolled. In adjusted analyses, ever experiencing disenrollment was associated with increased hazards of all-cause (hazard ratio [HR], 1.51; 95% CI, 1.23-1.84) and overdose mortality (HR, 1.56; 95% CI, 1.17-2.09). Compared with remaining enrolled and receiving MOUD treatment, being disenrolled (HR, 4.34; 95% CI, 3.19-5.89) and being enrolled and not receiving MOUD treatment (HR, 4.19; 95% CI, 3.24-5.43) were associated with overall mortality.

Conclusions and relevance: In this cohort study of patients who initiated MOUD, experiencing health plan disenrollment was associated with increased mortality risk compared with remaining enrolled. Strategies are needed to improve continuity of health coverage and mitigate the elevated mortality risk during insurance transitions for patients receiving medications for OUD.

Background and aims: Despite similar substance use levels, Black adults experience greater family, legal, employment and other social-contextual challenges related to recovery than other groups. Substance use treatments that address both substance use and social-contextual factors are uniquely positioned to address these substance-related problems and produce more sustainable improvements in social functioning than treatment as usual (TAU) or behavioral controls (Control). The aim of this study was to evaluate changes in substance-related problems among Black adults, focusing on the comparative effectiveness between social-contextual treatments and TAU/Control.

Design: Individual-level data synthesis based on secondary analysis of Black adults enrolled in the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN).

Setting: All data were collected in the primary studies between 2001 and 2008 at clinics across the United States.

Participants: Black adults who reported cocaine and/or opioid use across nine studies within the NIDA CTN. The sample used herein consisted of individuals from five of these studies who provided data on substance-related problems (n=532; mean age=39.34; standard deviation=9.6).

Measurements: There were two treatment conditions: Social-contextual (e.g. Motivational Interviewing, Seeking Safety, STAGE 12) and TAU/Control. Moderated nonlinear factor analysis estimated latent scores for substance-related problems, using subscales from the Addiction Severity Index, while accounting for measurement noninvariance across studies, time and covariates. Linear mixed models estimated latent score differences over time between social-contextual treatments and TAU/Control during treatment and from the end of treatment through 12-month follow-up.

Findings: Both treatment groups improved across substance-related problem areas from baseline to the end-of-treatment (Cohen’s d = -0.10 to d = -0.47), with effects maintained at 12-month follow-up. Although social-contextual treatments did not statistically significantly outperform TAU/Control from baseline to end-of-treatment, they showed greater effects from end of treatment to 12-month follow-up in family/social [Cohen’s d difference ( d) = -0.47, 95% confidence interval (CI) = -0.57 to -0.38], legal ( d = -0.20, 95% CI = -0.31 to -0.10) and psychiatric problems ( d = 0.29, 95% CI = -0.38 to -0.20) than TAU/Control. Sensitivity analyses indicated that Seeking Safety and STAGE 12 predominantly drove post-treatment improvements in family/social problems.

Conclusions: Substance use treatment may yield broader, delayed benefits beyond substance use reduction among Black adults in the United States. Compared with treatment-as-usual, social-contextual treatments can yield more sustainable effects in legal, family and psychiatric areas among Black adults, with interventions such as Seeking Safety and STAGE 12 showing particular benefits in addressing family-related challenges.

Related protocols: CTN-0125

Background and aim: Extended-release injectable naltrexone (XR-Naltrexone) is an effective treatment for opioid use disorder (OUD); however, initiation can be challenging as it requires an opioid-free period. This exploratory analysis examines patient characteristics associated with successful initiation of XR-Naltrexone in the National Drug Abuse Treatment Clinical Trials Network (CTN-0051) Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment (X:BOT) trial.

Methods: Patient demographics and clinical variables associated with successful XR-Naltrexone initiation were examined among 283 participants with OUD randomized to XR-Naltrexone in the X:BOT trial. Variables included severity of opioid use, characteristics of opioid and other substance use, treatment history, psychiatric history, baseline depression, and pain. Logistic regression models were used to estimate the effect of variables on the odds of induction success.

Results: 204 (72%) of 283 participants randomized to receive XR-Naltrexone completed successful induction. Housing status and pain were significantly associated with XR-Naltrexone induction status. Reported homelessness was significantly associated with higher odds of successful XR-Naltrexone induction (OR: 2.31; 95% CI: 1.12, 4.76). Individuals that reported moderate or extreme pain on the EuroQoL had half the odds of successful induction compared to those without pain (OR: 0.49; 95% CI: 0.27, 0.89).

Conclusions: Among patients with OUD initiating treatment on inpatient units, homelessness was associated with greater likelihood of successfully initiating XR-Naltrexone, while chronic pain was associated with lower likelihood of XR-Naltrexone initiation. Future research on XR-Naltrexone initiation should consider tailoring treatment based on housing status and other social determinants, and evaluation and management of pain.

Related protocols: CTN-0051

Background and aims: Sleep disruptions increase the risk of substance misuse. Substance use-especially stimulants-can increase acute and chronic sleep dysfunction. This study aimed to estimate the associations between sleep disturbance and stimulant use over time among participants with stimulant use disorder (StUD).

Design: In this secondary analysis, a Random Intercept Cross-Lagged Panel Model (RI-CLPM) was used to assess sleep disturbance and stimulant use over 8 weeks among participants with StUD.

Setting: United States of America.

Participants: The analysis included 793 participants with StUD enrolled across 3 randomized controlled trials in the National Institute on Drug Abuse’s Clinical Trials Network (CTN): CTN-0037, CTN-0048 and CTN-0068.

Measurements: Self-reported sleep disturbance was harmonized as a binary indicator across trial measures at each week. Stimulant use days per week were captured by Timeline Follow Back. Baseline covariates included age, sex, race/ethnicity, employment status, presence of depressive symptoms, any psychiatric history, treatment arm and trial.

Findings: Sleep disturbance was associated with a higher average number of stimulant use days the following week [β = 0.15, 95% confidence interval (CI) = 0.09, 0.22, P < 0.001], and greater stimulant use was linked to increased odds of subsequent sleep disturbance (odds ratio = 1.20, 95% CI = 1.14, 1.26, P < 0.001).

Conclusions: Higher-than-usual stimulant use appears to be associated with increased likelihood of sleep disturbance the following week, and vice versa.

Related protocols: CTN-0037, CTN-0048, CTN-0068

Background: Opioid use disorder (OUD) remains a significant public health issue. Yet, few primary care clinicians (PCCs) screen for, diagnose, or treat OUD. Clinical decision support tools (CDS) integrated into the electronic health record improve process and outcome measures across a variety of conditions. We evaluated PCC perspectives on an OUD CDS tool (Opioid Wizard) deployed through a clinic-randomized trial.

Methods: This is a secondary analysis of CTN-0095, a trial evaluating the effectiveness of Opioid Wizard on OUD process and outcome measures. In short, 92 primary care clinics across three health systems were randomized to Opioid Wizard or usual care. PCCs completed online surveys pre- and 9-month post-Opioid Wizard’s go-live date. Survey items measured PCC self-reports on their confidence and ability to manage OUD, and for PCCs in Opioid Wizard clinics, perceptions about the tool. Generalized linear mixed models with Poisson distribution estimated change in survey response from baseline to follow-up within each treatment group (risk ratios) and in intervention relative to control clinics (ratio of risk ratios).

Results: 361 PCCs (n = 180 Opioid Wizard, n = 181 usual care, 63% female) answered at least one survey. Confidence in screening (RR 1.32, 95% CI 1.07, 1.62), diagnosing (RR 1.24, 95% CI 1.02, 1.50), and referring (RR 1.17, 95% CI 1.02, 1.34) patients for OUD care significantly increased in Opioid Wizard clinics only. Confidence in treating OUD with buprenorphine did not increase in either setting. Of 55 PCCs who used Opioid Wizard at least once, 80% agreed Opioid Wizard made tasks easier and 70% agreed using Opioid Wizard was time “well spent,” but only 44% were likely to recommend it to colleagues.

Conclusion: Opioid Wizard increased PCC confidence across a variety of OUD care measures yet enthusiasm for and use of the tool was limited. Efforts to increase Opioid Wizard use may improve OUD care measures.

Related protocols: CTN-0095