*Background/Objectives:* Although estimates of opioid-related fatalities in
the United States indicate a decrease from 2017-2018, deaths associated
with the opioid epidemic continue to rise among low-income and minority
populations. Despite efficacy of medication for opioid use disorder (MOUD),
these populations are vulnerable to poor treatment outcomes. Peer recovery
coaches (PRCs), individuals with lived experience of substance use and
recovery, are well-positioned to engage vulnerable patients. Traditionally,
PRCs have focused on bridging to care rather than delivering interventions
themselves. This study used qualitative methods to solicit feedback on
feasibility and acceptability of PRC-delivered Behavioral Activation (BA)
to support retention in MOUD by increasing positive reinforcement.
*Methods:* This study was conducted at a community-based drug treatment
center that serves low-income, minority patients and reports an average 49%
retention at six months post-treatment initiation. We recruited patients
and staff as well as PRCs who work across the city. Semi-structured
interviews and focus groups inquired about feasibility and acceptability of
a BA intervention, recommendations for adaptation for the target
population, and comfort working with a peer in the context of MOUD.
*Results:* Participants (*n*=20) had a mean age of 48.4 (SD=10.0), were 70%
male, and 60% Black or African American. Staff and PRC participants (*n*=12)
had a mean age of 49.2 (SD=0.7), were 42% male, 75% Black or African
American, with an average of 9.6 years working in substance use treatment.
Participants shared that PRC-delivered BA could be feasible and acceptable
with adaptations, including emphasis on PRC-led/taught activities. They
described common challenges associated with unstructured time, for which BA
could be particularly relevant.
*Conclusions:* Improving MOUD outcomes is a national priority that must be
met with cost-effective, sustainable strategies to support individuals in
treatment. Qualitative feedback suggests PRCs may be effective in this
effort and our research findings inform an upcoming PRC-delivered BA trial.
*Keywords*: peer recovery coaches, medication treatment for opioid use
disorder, evidence-based interventions, implementation science
