Optimized Interventions to Prevent Opioid Use Disorder among Adolescents and Young Adults in the Emergency Department

项目摘要 年龄较大的青少年和年轻人(16-30岁)使用阿片类药物是一个重大的公共卫生问题 需要可扩展的方法来预防阿片滥用和阿片使用障碍(OID)。的一个独特功能 阿片类药物危机是迅速演变的临床后遗症，其中包括基于以下原因使用阿片类药物的变化 发展获得处方药的机会(例如，由于重新安排时间、处方药监测计划)， 街头阿片类药物和新配方(如非法制造的芬太尼)的可获得性，以及不同的途径 与使用升级相关的给药(例如，口服、鼻塞、注射)。一次医疗访问提供了 确定和干预面临阿片类药物滥用风险的AYA的接入点/OUD以改变风险轨迹。这个 急诊科(ED)是联系AYAS的理想场所，特别是在年轻人可能会断线的情况下 从儿科医学过渡到初级保健。ED也是阿片类药物的常见来源 处方。尽管我们之前在有效的ED短期干预(BIS)方面的工作取得了令人振奋的发现，但 减少阿片类药物滥用/过量风险和其他物质使用(我们的酒精BI二级分析减少 处方药滥用)，适度的效果规模限制了单次国际清算银行对公众健康的影响。此外，我们 缺乏关于如何扩大干预措施以实现最大影响的关键数据，同时节省资源和简化 在医疗保健环境中实施。拟议的研究将评估不同干预措施的效果 类型/强度，采用四组随机对照试验设计进行检验。拟议的工作充分利用了 吸引AYAS的技术，以促进健康教练(HCS)的干预交付，促进 Fidelity以及根据快速变化的阿片类药物情况进行实时定制。具体的 目标是：1)适应有希望的HC提供的干预措施和试点试验在AYA中的可行性/可接受性(UG3)； 2)评估干预措施及其组合在预防/减少阿片类药物滥用和药物滥用方面的效果 3)审查教育的执行情况和可持续性，包括经济评估 (UH3)。次要目标是检查对其他物质使用的有效性，以及调节因素(例如，性别、动机、 阿片类药物风险严重程度)和结果的中介因素(如自我效能、改变动机)。阿亚斯(16-30岁； 在ED筛查中，阿片类药物使用阳性(+≥1风险因素)或滥用将根据风险严重程度分层 和性别，并随机分配到两种基于ED的情况之一[(HC通过远程提供的签到BI 视频聊天，或增强型日常护理手册(EUC)]，通过门户网站(登记)发送或不发送HC消息 门户4周)。因此，这四个条件是：仅EUC、仅BI、仅门户、BI+门户以及结果 分别在4个月、8个月和12个月时测量。这项研究是创新的，通过测试干预措施的有效性 预防/减少阿片类药物滥用/OUD，这在医疗保健系统中是可行的。技术-- 通过HC提供的驱动型、可扩展的干预措施允许实时定制以适应快速变化的阿片类药物 这可能对防止阿片类药物滥用在阿片类药物滥用中的升级产生很大的、可持续的影响。

Project Summary Opioid use by older adolescents and young adults (AYAs; ages 16-30) is a significant public health concern requiring scalable approaches to prevent opioid misuse and opioid use disorders (OUDs). A unique feature of the opioid crisis is the rapidly morphing clinical sequela, which includes changes in opioids used based on evolving access to prescription medicines (e.g., due to rescheduling, prescription drug monitoring programs), availability of street opioids and new formulations (e.g., illicitly made fentanyl), and varying routes of administration associated with escalation in use (e.g., oral, snorting, injection). A health care visit provides an access point to identify and intervene with AYAs at risk for opioid misuse/OUD to alter risk trajectories. The emergency department (ED) is an ideal venue to reach AYAs, particularly as young adults may disconnect from primary care when transitioning out of pediatric medicine. The ED is also common source of opioid prescriptions. Despite promising findings from our prior work on efficacious ED brief interventions (BIs) that reduced opioid misuse/overdose risk, and other substance use (secondary analyses of our alcohol BI reduced prescription drug misuse), modest effect sizes limit the public health impact of one-session BIs. Further, we lack critical data on how to extend interventions for maximal impact, with parsimony of resources and ease of implementation in healthcare settings. The proposed study will evaluate the efficacy of interventions of varying type/intensity, tested using a four group randomized controlled trial design. The proposed work leverages technology that is appealing to AYAs to facilitate intervention delivery by health coaches (HCs), promoting fidelity along with real-time tailoring in accordance with the rapidly changing opioid landscape. The specific aims are to: 1) adapt promising HC-delivered interventions and pilot test feasibility/acceptability in AYAs (UG3); 2) evaluate the efficacy of interventions and their combinations on preventing/reducing opioid misuse and OUD among AYAs (UH3); and 3) examine ED implementation and sustainability, including economic evaluation (UH3). Secondary aims are to examine efficacy on other substance use, and moderators (e.g., sex, motives, opioid risk severity) and mediators (e.g., self-efficacy, motivation to change) of outcome. AYAs (ages 16-30; N=1170) in the ED screening positive for opioid use (+ ≥1 risk factor) or misuse will be stratified by risk severity and sex and randomly assigned to one of two ED-based conditions [(Check-In BI delivered by HC via remote video chat, or enhanced usual care brochure (EUC)], with or without HC messaging via web portal (Check-In Portal for 4 weeks). Thus, the four conditions are: EUC only, BI only, Portal Only, BI + Portal, with outcomes measured at 4-, 8-, and 12-months. This study is innovative by testing the efficacy of interventions to prevent/reduce opioid misuse/OUD, which are feasible to implementation in healthcare systems. Technology- driven, scalable interventions via HC delivery allow for real-time tailoring to the rapidly changing opioid epidemic, which could have high, sustainable impact on preventing escalation of opioid misuse among AYAs.