DAT18-08 Geographic variation in Opioid Addiction Treatment (GATE) study: Multi-Level Factors Influencing MAT Use, Other Treatment, & Adverse Outcomes among Re-entering Rural and Urban Prisoners

DAT18-08 阿片类药物成瘾治疗 (GATE) 研究的地理差异：影响 MAT 使用的多层次因素、其他治疗、

• 批准号: 10163832
• 负责人: CARRIE BETH OSER
• 金额: $ 59.91万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10163832
• 关键词: Address; Aftercare; Back; Caring; Characteristics; Communities; Continuity of Patient Care; County; Crime; Criminal Justice; Data; Distal; Drug Screening; Drug usage; Economically Deprived Population; Education; Elements; Enrollment; Equipment and supply inventories; Foundations; Future; Geographic Locations; Geography; Goals; Health; Health Services Accessibility; Healthcare; Imprisonment; Individual; Injectable; Intervention; Interview; Kentucky; Knowledge; Literature; Longitudinal cohort study; Measures; Mediating; Medicaid; Mentors; Methods; Naltrexone; National Institute of Drug Abuse; Opiate Addiction; Outcome; Outpatients; Overdose; Persons; Pharmaceutical Preparations; Pilot Projects; Predictive Factor; Prisoner; Prisons; Process; Public Health; Recovery; Relapse; Reproducibility; Research; Resources; Rural; Rural Appalachia; Rural Population; Safety; Sampling; Science; Social Network; Social Work; Structure; Substance abuse problem; Supervision; Support Groups; Surveys; System; Time; Treatment outcome; United States National Institutes of Health; Urban Population; Validation; Variant; Woman; addiction; adverse outcome; base; effective therapy; evidence base; experience; follow-up; geographic difference; improved; interest; offender; opioid epidemic; opioid misuse; opioid use disorder; primary outcome; programs; prospective; recidivism; recruit; relapse risk; response; social; social structure; uptake; willingness

ABSTRACT: As outlined in DAT18-08, NIDA has a strong interest in understanding treatment utilization among persons with opioid use disorders (POUDs) as they transition from prison to the community, because treating individuals with opioid use disorder (OUD) simultaneously improves public health and public safety. Kentucky is in the midst of an opioid crisis, with many POUDs cycling through the criminal justice system each year. While evidenced-based medications for addiction treatment (MAT) exist for treating OUD, MAT is underutilized within prisons, which elevates the risk of relapse and overdose when POUDs are released and re-enter their communities. Research is scant regarding the multi-level factors associated with offenders’ willingness to initiate MAT while in prison and their continued engagement in treatment after release. Furthermore, rural and urban populations have not been compared. In response to NIDA DAT18-08, we propose to conduct the high-impact Geographic variation in Addiction Treatment (GATE) study, which will address the knowledge gap on multi-level factors influencing prison-based extended-release injectable naltrexone (XR-NTX) initiation as well as examine predictors of post-release MAT use and adverse outcomes (i.e., relapse, overdose, recidivism) among both rural and urban POUDs. This mixed methods study employs a social ecological framework to understand individual characteristics that influence MAT initiation and adverse outcomes, as well as contexts more distal to the individual, including social networks and structural factors. The specific aims of the GATE study are: 1) to identify the individual, personal network, and structural factors associated with XR-NTX initiation in prison among rural, as compared to urban, POUDs, and 2) to examine the individual, personal network, and structural factors predicting MAT use, treatment use, and adverse outcomes in the community among re-entering rural, as compared to urban, POUDs over time. A prospective observational longitudinal cohort study will be conducted with 500 POUDs, using survey and social network data collected in prison and at 6- and 12-months post-release to explore multi-level rural-urban variation in key outcomes. In-depth guided qualitative interviews will be conducted with POUDs, prison-based treatment staff, and social service clinicians. To maximize rigor and reproducibility, we will employ a concurrent triangulation strategy, whereby qualitative and quantitative data contribute equally to the analysis and are used for cross-validation. This study is led by a qualified interdisciplinary team and is the first mixed methods study examining the processes of social influences that occur in rural and urban social networks as POUDs transition from prison back to geographically diverse counties. The GATE study will enhance our ability to address the opioid epidemic within the correctional contexts of prisons and community supervision by informing process improvement efforts for prison-based MAT initiation and post-release retention in care, applying network science findings to improve the re-entry planning process, and establishing the foundation for future R-level intervention applications.

摘要：正如 DAT18-08 中所述，NIDA 对了解治疗利用情况抱有浓厚的兴趣。 患有阿片类药物使用障碍 (POUD) 的人从监狱过渡到社区时，因为治疗 患有阿片类药物使用障碍 (OUD) 的个体可同时改善公共健康和公共安全。肯塔基州 正处于阿片类药物危机之中，每年都有许多 POUD 进入刑事司法系统。尽管 存在用于治疗 OUD 的循证药物成瘾治疗 (MAT)，但 MAT 在国内未得到充分利用 监狱，当 POUD 被释放并重新进入监狱时，这会增加旧病复发和吸毒过量的风险 社区。关于与犯罪者主动发起意愿相关的多层次因素的研究很少 MAT 在监狱中以及出狱后继续接受治疗。此外，农村和城市 人群尚未进行比较。为了响应 NIDA DAT18-08，我们建议开展高影响力的 成瘾治疗（GATE）研究的地理差异，这将解决多层次的知识差距 影响监狱缓释注射纳曲酮 (XR-NTX) 启动的因素以及检查 农村和农村地区释放后 MAT 使用和不良后果（即复发、服药过量、累犯）的预测因素 和城市 POUD。这项混合方法研究采用社会生态框架来理解个体 影响 MAT 启动和不良结果的特征，以及更远离目标的背景 个人，包括社交网络和结构因素。 GATE 研究的具体目标是： 1) 确定与 XR-NTX 启动相关的个人、个人网络和结构因素 与城市、POUD 相比，农村监狱，以及 2) 检查个人、个人网络， 预测 MAT 使用、治疗使用和社区不良后果的结构因素 与城市相比，重新进入农村的 POUD 随着时间的推移而增加。前瞻性纵向观察 队列研究将利用在监狱和监狱中收集的调查和社交网络数据，对 500 名 POUD 进行 在发布后 6 个月和 12 个月进行研究，以探索关键结果的多层次城乡差异。深度指导 将与 POUD、监狱治疗人员和社会服务临床医生进行定性访谈。 为了最大限度地提高严谨性和可重复性，我们将采用并发三角测量策略，从而定性 定量数据同样有助于分析并用于交叉验证。这项研究由一位 合格的跨学科团队，是第一个检查社会影响过程的混合方法研究 随着 POUD 从监狱过渡到地域多样化，农村和城市社交网络中发生的事情 县。 GATE 研究将增强我们在惩教环境中解决阿片类药物流行问题的能力 通过为基于监狱的 MAT 启动过程改进工作提供信息，加强监狱和社区监督 和释放后保留护理，应用网络科学发现来改进重返计划过程， 并为未来R级干预应用奠定基础。