Project Summary I am a well-published, early stage medical sociologist applying for a NIDA-funded Racial Equity Visionary Award focused on the feasibility, acceptability, and preliminary efficacy of an innovative, mixed methods, community- engaged intervention targeting non-Hispanic Black (NHB) individuals with opioid use disorder (OUD). This study will apply my understanding of community needs and OUD, to test a novel intervention in a scalable setting, leveraging my role as a leader in this field to disseminate findings and improve treatment access nationwide. Opioid-related overdoses are increasing fastest in NHB individuals. In 2020, amid the COVID-19 pandemic, NHB overdose deaths increased by 45%, nearly double the increase in non-Hispanic Whites (NHW). Disproportionate increases in overdoses correspond to racial inequities in OUD treatment access and utilization. An effective treatment, buprenorphine, is concentrated among communities with high percentages of NHWs, higher income, and private insurance. Compared with NHW patients with OUD, NHB patients with OUD are 77% less likely to have an office visit that includes a buprenorphine prescription, despite similar prevalence of OUDs. This structural problem is at the foundation of my proposed research. Research focused on developing and testing culturally effective, community grounded, and structurally competent OUD treatments with rigorous implementation assessments is urgently needed to intervene on structural barriers to OUD treatment that operate in settings in which NHB individuals seek healthcare. Significant federal funding has expanded access to OUD treatment services in Community Health Centers (CHCs) that provide care to underserved populations and areas but barriers to accessing care remain in NHBs. I propose to prepare for a fully powered clinical trial by testing whether a buprenorphine treatment intervention protocol (Racial Equity in Systems to Treat Opioid Use Disorder for Everyone—RESTORE) that targets structural barriers to OUD treatment for NHB individuals is feasible in the context of CHCs. RESTORE draws upon concepts of structural competency, peer navigation, and culturally grounded OUD education for both patients and providers. Community engagement will be continuous, exemplified by the use of peer navigators to connect patients to care. RESTORE will be based in Southern California—an epicenter of the nation’s opioid crisis. Project Phases, guided by cutting edge implementation science, include 1) a qualitative investigation into provider and patient barriers to and facilitators of CHCs’ provision of buprenorphine specifically to NHB individuals with OUD; 2) the operationalization of RESTORE into routine care, using preliminary findings from Phase I; and 3) a pilot stepped-wedge randomized controlled trial to test the feasibility, acceptability, and preliminary efficacy of RESTORE, as well as the protocols, procedures and training in CHCs. This study has the potential to...