PROJECT SUMMARY This proposal presents a curriculum and research plan focused on the services of Peer Recovery Specialists (PRS) to improve patient retention in opioid use disorder (OUD) treatment in primary care. PRS are individuals in recovery who use their experience and training to provide emotional support to patients, motivate behavior change, and help patients overcome the barriers to treatment engagement and retention. Currently, the approved standard for treating persons with OUD in primary care is medication-assisted treatment (MAT), which combines medications – most commonly, buprenorphine – with counseling or behavioral therapy. However, most patients who begin buprenorphine treatment discontinue within the first 6 months, which elevates the risk of relapse, overdose, morbidity and mortality. In Aim 1 of the research plan, I will identify the structures, functions, resources and practices of a diverse set of primary care PRS programs and their potential for increasing OUD treatment retention. Data will be collected through (a) a detailed survey of program characteristics, including PRS recruitment, qualifications, hiring practices, training and professional development, supervision, caseloads, patient matching, specific tasks performed, frequency and mode of patient contacts, incentives, and integration into the larger care team; (b) 3- 5 days of direct observation at 7-10 sites to capture PRS behavior and context; and (c) in-depth interviews with patients, PRS, clinicians, and care team members. The studies will provide a granular understanding of the scope, organization, and operational differences in PRS services and their potential effect on OUD treatment retention. In Aim 2, a planning group of community stakeholders, OUD and PRS experts will guide the development of an enhanced model of peer support services that combines the components and priorities most likely to provide a cost-effective, robust intervention for OUD treatment retention in primary care. In Aim 3, I will pilot test the enhanced model in a primary care MAT clinic with a small sample of adult patients. The pilot will be a 180-day intervention designed to test the program logistics, operations, training, data collection, and overall management. I will assess the feasibility and acceptability of the intervention, and the fidelity and sustainability of its implementation in preparation for a future R01 randomized controlled trial. Our proposal aligns closely with the National Institute on Drug Abuse (NIDA) 2016-2020 strategic plan to develop and test strategies for effectively and sustainably implementing evidence-based treatments (Objective 3.4), and with the goals of the NIDA 2021-2025 draft outline strategic plan to develop and test novel prevention, treatment and recovery support strategies (Goal 2), and to implement evidence-based strategies in real-world settings (Goal 3). The proposed research and didactic work will position the candidate with a unique set of...