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

预防急诊科青少年和年轻人阿片类药物使用障碍的优化干预措施

• 批准号: 10212539
• 负责人: Erin E. Bonar
• 金额: $ 517.17万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10212539
• 关键词: Accident and Emergency department; Achievement; Adolescent and Young Adult; Adult; Age; Alcohol or Other Drugs use; Alcohols; Cannabis; Childhood; Clinical; Computer software; Computerized Medical Record; Data; Development; Drug usage; Emergency department screening; Emergency department visit; Evaluation; Fentanyl; Formulation; Health; Health Care Visit; Healthcare Systems; Heroin; Heterogeneity; Injections; Intention; Intervention; Life; Maintenance; Mediator of activation protein; Medicine; Mental Health; Morbidity - disease rate; Motivation; National Institute of Drug Abuse; Online Systems; Opioid; Oral; Outcome; Outcome Measure; Overdose; Pain interference; Pamphlets; Phase; Prevention; Prevention strategy; Primary Health Care; Public Health; Randomized; Randomized Controlled Trials; Research; Resources; Risk; Risk Behaviors; Risk Factors; Route; Self Efficacy; Services; Severities; Source; Structure; Surveys; Technology; Telemedicine; Testing; Therapeutic; Time; Treatment Efficacy; Work; base; brief alcohol intervention; brief intervention; cost; cost effective; economic evaluation; efficacy testing; experience; health care settings; health data; health service use; illicit opioid; impaired driving performance; innovation; misuse of prescription only drugs; mobile application; mortality; motivational enhancement therapy; opioid epidemic; opioid misuse; opioid overdose; opioid use; opioid use disorder; overdose risk; patient portal; pill; prescription monitoring program; prescription opioid; prevent; primary outcome; reduced substance use; risk perception; secondary analysis; sex; substance misuse; treatment as usual; trial design; web portal; young adult

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.

项目摘要 年龄较大的青少年和年轻人（AYAs; 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类药物滥用和阿片类药物使用障碍（OUD）。的独特特征 阿片类药物危机是一种迅速变化的临床后遗症，包括基于阿片类药物使用的变化， 不断发展的处方药获取途径（例如，由于重新安排，处方药监测程序）， 街头类阿片和新制剂的供应情况（例如，非法制造的芬太尼），以及各种途径的 与使用升级相关的给药（例如，口服、鼻吸、注射）。医疗保健访问提供了一个 识别和干预有阿片类药物滥用/OUD风险的AYA的接入点，以改变风险轨迹。的 急诊科（艾德）是接触AYA的理想场所，特别是年轻人可能会断开连接 从初级保健过渡到儿科医学。艾德也是阿片类药物的常见来源 处方尽管我们先前关于有效的艾德简短干预（BI）的工作有希望的发现， 减少阿片类药物滥用/过量风险和其他物质使用（对我们的酒精BI的二次分析减少 处方药滥用），适度的效应量限制了一次性BI的公共卫生影响。我们还 缺乏关于如何扩大干预措施以产生最大影响的关键数据，资源贫乏， 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有效性， 类型/强度，使用四组随机对照试验设计进行测试。拟议的工作利用了 吸引AYAs的技术，以促进健康教练（HC）的干预提供，促进 保真度沿着，并根据快速变化的阿片类药物环境进行实时调整。具体 目的是：1）适应有前途的人力资源提供的干预措施和试点测试的可行性/可接受性在AYA（UG 3）; 2)评价干预措施及其组合对预防/减少阿片类药物滥用和OUD的有效性 3）审查艾德的实施和可持续性，包括经济评估 （UH3）。次要目的是检查对其他物质使用的有效性，以及调节剂（例如，性动机 阿片样物质风险严重性）和介质（例如，自我效能、改变动机）。AYAs（16-30岁; N=1170），将按风险严重程度对艾德筛选时阿片类药物使用（+ ≥1个风险因素）或误用阳性的患者进行分层 和性别，并随机分配至两种基于ED的条件之一[（由HC通过远程 视频聊天或增强型常规护理手册（EUC）]，通过门户网站（登记）发送或不发送HC消息 门户网站4周）。因此，这四个条件是：仅EUC、仅BI、仅门户、BI +门户，以及结局 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输送驱动的、可扩展的干预措施允许根据快速变化的阿片类药物进行实时调整 这一流行病可能对防止AYA中阿片类药物滥用的升级产生高度可持续的影响。