# Changing our paths: Well-being and recovery among American Indians with opioid use disorder

> **NIH NIH R33** · UNIVERSITY OF MINNESOTA · 2022 · $735,883

## Abstract

PROJECT SUMMARY
American Indians (AI) in Minnesota have 5-6x the opioid overdose death rate of other groups, and this figure
continues to rise. Medication-assisted treatment (MAT) is the standard of care for opioid use disorder (OUD)
treatment, but implementation and uptake has been slow nationally, especially for AI communities. Thus, there
is an urgent need to understand multi-level barriers and facilitators of OUD treatment, including how AI cultural
knowledge and practices can be interwoven within OUD treatment and how engagement can be improved
along all points of the OUD “Cascade of Care” (CoC). This project will involve a partnership between the
University of Minnesota Medical School, Duluth Campus, and a rural Minnesota tribal Nation. The overall
objective of this application is to characterize the OUD CoC in a reservation-based, tribal treatment context.
Our central hypothesis is that AIs benefit from MAT programs and OUD treatment, but there are multi-level
barriers and facilitators that affect implementation of the CoC, some unique to tribal communities. The rationale
for this project is that careful assessment of factors influencing the OUD CoC with AIs will optimize treatment
implementation and ultimately reduce opioid-related heath inequities. The preparatory R61 aims include (1)
characterizing the OUD CoC in a tribal context and delineating its components and transition points using
community-based participatory research (CBPR) methods and data from existing sources; (2) identifying
barriers and facilitators to engagement with the OUD CoC at key transition points via interviews with clinical
stakeholders and individuals with OUD and their families, and (3) preparing and confirming feasibility of
observational longitudinal data collection (R33 Aim 1) by developing and piloting study protocols and
measures. The R33 aims include: (1) prospectively examining barriers and facilitators to treatment
engagement and clinical outcomes defined within the CoC among 200 AIs with OUD after initial MAT clinic
intake assessment, and (2) identifying a set of culturally-centered, evidence-based implementation strategies
to address barriers and optimize treatment engagement across the CoC. The proposed project will leverage
and complement the tribe’s SAMHSA Tribal Opioid Response and MAT Prescription Drug and Opioid Addiction
funding. It is innovative because it considers barriers and facilitators across the entire OUD CoC in a tribal
context, and is one of the first studies to apply a dissemination and implementation lens to opioid research with
AI communities. The expected outcomes of the research include a culturally-centered description of the OUD
Cascade of Care with identified implementation strategies to address barriers to engagement. Findings would
provide generalizable scientific knowledge to optimize OUD services to reduce opioid-related health inequities
for American Indians.

## Key facts

- **NIH application ID:** 10625206
- **Project number:** 4R33DA049386-03
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** Brenna Greenfield
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $735,883
- **Award type:** 4N
- **Project period:** 2019-06-01 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10625206

## Citation

> US National Institutes of Health, RePORTER application 10625206, Changing our paths: Well-being and recovery among American Indians with opioid use disorder (4R33DA049386-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10625206. Licensed CC0.

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