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.

项目总结