Prevention of OUD: The HOME (Housing, Opportunities, Motivation and Engagement) Randomized Trial

摘要 虽然阿片类药物在普通人群中的使用近年来受到了媒体和学术界的广泛关注， 多年来，关于无家可归或流落街头的青年使用类阿片的研究很少。无家可归青年 比非无家可归的同龄人有更高的物质使用率，有证据表明无家可归者 在该国青年亚群中，青年类阿片使用率最高（Brands等人，2005）;海洛因 使用无家可归的年轻人似乎也具有最高的静脉注射药物使用率和HIV感染率（Rhoades等人，2014）。 鉴于阿片类药物使用率高，暴露于暴力，精神和身体健康挑战， 无家可归青年的死亡率，令人惊讶的是，迄今为止没有研究使用随机对照 旨在测试在这一弱势群体中预防阿片类药物和其他药物使用的措施。即使在那些 接受风险降低干预措施的人，缺乏稳定的住房似乎是减少风险行为的障碍 （DesJarlais等人，2007年）。通过住房和预防服务解决青年无家可归问题， 在目前的研究中提出的“住房第一”，有很大的潜力，以减少 阿片类药物使用障碍的发展以及与生活在 街道然而，只有20-30%的无家可归的青年样本报告说曾经住在危机避难所，9%的人说曾经住在危机避难所。 报告曾接受过心理健康服务，15%的人报告曾接受过药物使用 治疗（Ray，2006年），表明需要接触青年并使其参与可行的服务， 可以接受的这项研究将为研究人员和供应商提供关于 在阿片类药物使用的RCT中，住房+阿片类药物和相关风险预防服务，调节剂如何影响 反应和变化的机制。我们的干预和假设是由我们的 结合生物心理社会模型的概念模型（福代斯等人，（1973）生态社会 系统理论（Bronfenbrenner，1979）和班杜拉的社会认知理论（1977; 1986）。面试， 生理和自我报告方法将用于数据收集。研究的I期（UG 3）包括 对21名青年进行的试点研究，以评估手册的初步疗效、招募可行性和可接受性。 住房+阿片类药物和相关风险预防服务。在达到过渡里程碑后，240名青年将 被招募参加一项更大规模的随机临床试验，测试住房+阿片类药物和相关风险预防服务 与单独的阿片类药物和相关风险预防服务相比（第二阶段，UH 3）。随访将在3、6、 基线后9和12个月。将确定每项干预措施的经济成本，以告知未来 供应商及其资助者。该项目利用现有的有效预防模式， 新的信息对于向高度脆弱的青年这一特殊群体提供预防服务至关重要。 由于无家可归的青年面临各种不利后果的风险增加， 拟议的干预措施可能会给青年和整个社会带来巨大的保健利益。

Abstract While opioid use in the general population has received significant media and scholarly attention in recent years, very little research exists on opioid use among homeless or street-involved youth. Homeless youth have a much higher rate of substance use than non-homeless peers with evidence suggesting that homeless youth have the highest rates of opioid use among youth subgroups in the country (Brands et al., 2005); heroin using homeless youth also appear to have the highest rates of IV drug use and HIV (Rhoades et al., 2014). Given the high rates of opioid use, exposure to violence, mental and physical health challenges, and high rates of mortality in homeless youth, it is surprising that no study to date utilizes a randomized controlled design to test prevention of opioid and other drug use among this vulnerable population. Even among those receiving risk reduction interventions, lack of stable housing appears to be a barrier to reducing risk behaviors (DesJarlais et al., 2007). Resolution of youth homelessness through housing and prevention services, often referred to as “Housing First”, as proposed in the current study, has great potential to reduce the likelihood for the development of an opioid use disorder as well as other problem behaviors associated with living on the streets. However, only 20-30% of homeless youth samples report ever having stayed at a crisis shelter, 9% report having ever accessed mental health services, and 15% report ever having received substance use treatment (Ray, 2006) indicating a need to reach and engage youth in services that are feasible and acceptable. This study will provide essential information for researchers and providers on the efficacy of housing + opioid and related risk prevention services in an RCT on opioid use, how moderators affect the response, and mechanisms underlying change. Our intervention and hypotheses are guided by our conceptual model incorporating the biopsychosocial model (Fordyce et al., 1973) with social ecological systems theory (Bronfenbrenner, 1979) and Bandura’s Social-Cognitive Theory (1977; 1986). Interview, physiological, and self-report methods will be used for data gathering. Phase I (UG3) of the study includes a pilot study with 21 youth to assess initial efficacy, feasibility of recruitment and acceptability of the manualized housing + opioid and related risk prevention services. Upon meeting transition milestones, 240 youth will then be recruited for a larger randomized clinical trial testing housing + opioid and related risk prevention services versus opioid and related risk prevention services alone (Phase II, UH3). Follow-up will be conducted at 3, 6, 9 and 12-months post-baseline. The economic cost of each intervention will be determined to inform future providers and their funders. This project utilizes existing efficacious models of prevention to generate valuable new information critical to prevention services delivery for a special population of highly vulnerable youth. Because youth experiencing homelessness are at increased risk for a variety of adverse outcomes, the proposed intervention may produce substantial health-care benefits to the youths and society at large.