Facilitating the Implementation of Interim Methadone to Increase Treatment Access: A Multi-Site Implementation Trial

促进临时美沙酮的实施以增加治疗机会：多地点实施试验

• 批准号: 10222634
• 负责人: ROBERT P SCHWARTZ
• 金额: $ 133.95万
• 依托单位: FRIENDS RESEARCH INSTITUTE, INC.
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222634
• 关键词: Academic Detailing; Address; Admission activity; Adoption; Adult; Alcohol abuse; Awareness; Baltimore; Clinic; Clinical; Clinical effectiveness; Collaborations; Counseling; Data; Data Collection; Drug abuse; Effectiveness; Evaluation; Evidence based practice; Evidence based program; Feedback; Funding; HIV Infections; Health Services Accessibility; Healthcare; Individual; Intervention; Interview; Lead; Leadership; Learning; Manuals; Measures; Mental Health; Methadone; Modeling; National Institute of Drug Abuse; Opioid; Outcome; Paper; Patients; Performance; Pharmacotherapy; Primary Health Care; Procedures; Public Health; Registries; Regulation; Reporting; Research; Research Design; Risk; Services; Site; Structure; Substance Abuse Treatment Centers; Supervision; Test Result; Training; Treatment Cost; United States Substance Abuse and Mental Health Services Administration; Urine; Waiting Lists; Work; authority; design; effective therapy; effectiveness evaluation; effectiveness implementation study; health care service organization; illicit opioid; implementation facilitation; implementation outcomes; implementation trial; innovation; interest; medication administration; methadone patient; methadone treatment; operation; opioid agonist therapy; opioid epidemic; opioid mortality; opioid treatment program; opioid use; opioid use disorder; outreach; overdose death; primary outcome; programs; randomized trial; recruit; scale up; substance abuse treatment; trial design; uptake

The US is facing an unprecedented opioid epidemic. Methadone treatment is effective in reducing illicit opioid use and overdose death, yet waiting lists for Opioid Treatment Programs (OTPs) persist in numerous states. Federal regulations since 1993 permit the provision of interim methadone (IM) treatment – consisting of supervised methadone administration without routine counseling – for up to 120 days for people on OTP waiting lists. IM is on federal Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices. Two randomized trials, including one conducted by our team, have shown that IM treatment is more effective than waiting list in increasing OTP admission and reducing illicit opioid use. Our team led the successful implementation and evaluation of IM in six Baltimore OTPs for 1,000 patients over an 18-month period. The Center for Substance Abuse Treatment recently commissioned the PI to author a white paper on IM that found barriers to the implementation of IM include lack of awareness and misconceptions about IM among some State Opioid Treatment Authorities (SOTAs) who must recommend its approval and OTP Directors who must implement it. Despite the ongoing opioid epidemic, IM’s effectiveness, and the persistence of OTP waiting lists, IM has rarely been used outside of research. Research is needed to find an effective approach to spur IM’s implementation. This application proposes a Type 3 implementation effectiveness study using a stepped-wedge randomized trial design in the context of Proctor’s implementation model. This study will adapt, deploy, and assess the effectiveness of an Implementation Facilitation strategy to spur the use of IM treatment. In this strategy, the PI will serve as the external facilitator to work with the National Association of State Alcohol and Drug Abuse Directors to co-lead a learning collaborative for participating SOTAs and OTP leadership of nine participating OTPs with waiting lists. Local OTP champions will be recruited and the PI will provide academic detailing, IM procedures training, and performance feedback to OTP staff. The IM operations manual from the team’s previous work will be used to train OTP staff. The Implementation Facilitation intervention will occur in 9 OTPs, and will include data collection for an estimated 6,120 adults on OTP waiting lists and 1,710 IM treatment admissions. The primary implementation outcome (Accessibility to methadone treatment), as well as secondary implementation (Uptake, Efficiency, Fidelity, Sustainability, Feasibility, and Acceptability) and clinical effectiveness (urine opioid testing results) outcomes will be measured using a combination of de-identified OTP data and qualitative SOTA and OTP staff semi- structured interviews. The proposed study is highly significant because it could demonstrate an effective approach to spur the implementation of IM treatment to reduce OTP waiting lists. This study is innovative in applying Implementation Facilitation, an approach used in mental health and primary care, to spur a significant change in how OTPs address the gap between treatment demand and capacity.

美国正面临着前所未有的阿片类药物泛滥。美沙酮治疗对减少非法阿片类药物有效

项目成果

Patient perspectives on community pharmacy administered and dispensing of methadone treatment for opioid use disorder: a qualitative study in the U.S.

• DOI: 10.1186/s13722-023-00399-6
• 发表时间: 2023-08-02
• 期刊: ADDICTION SCIENCE & CLINICAL PRACTICE
• 影响因子: 3.7
• 作者: Wu, Li-Tzy;John, William S.;Mannelli, Paolo;Morse, Eric D.;Anderson, Alyssa;Schwartz, Robert P.
• 通讯作者: Schwartz, Robert P.

Opioid treatment program culture and philosophy: Views of OTP staff and state officials on implementing interim methadone treatment.

阿片类药物治疗计划文化和理念：OTP 工作人员和州官员对实施临时美沙酮治疗的看法。

• DOI: 10.1016/j.josat.2023.209265
• 发表时间: 2024
• 期刊: Journal of substance use and addiction treatment
• 作者: Burruss-Cousins,Karen;Mitchell,ShannonGwin;Gryczynski,Jan;Whitter,Melanie;Fuller,Douglas;Ibrahim,Adila;Schwartz,RobertP
• 通讯作者: Schwartz,RobertP

Opioid treatment program and community pharmacy collaboration for methadone maintenance treatment: results from a feasibility clinical trial.

• DOI: 10.1111/add.15641
• 发表时间: 2022-03
• 期刊: Addiction (Abingdon, England)
• 作者: Wu LT;John WS;Morse ED;Adkins S;Pippin J;Brooner RK;Schwartz RP
• 通讯作者: Schwartz RP

Addiction Medicine Practice-Based Research Network (AMNet): Assessment Tools and Quality Measures.

基于成瘾医学实践的研究网络（AMNet）：评估工具和质量措施。

• DOI: 10.2147/sar.s305972
• 发表时间: 2021
• 期刊: Substance abuse and rehabilitation
• 影响因子: 1.8
• 作者: Clarke DE;Ibrahim A;Doty B;Patel S;Gibson D;Pagano A;Thompson L;Goldstein AB;Vocci F;Schwartz RP
• 通讯作者: Schwartz RP

Impact of COVID-19-related methadone regulatory flexibilities: views of state opioid treatment authorities and program staff.

• DOI: 10.1186/s13722-023-00417-7
• 发表时间: 2023-10-17
• 期刊: ADDICTION SCIENCE & CLINICAL PRACTICE
• 影响因子: 3.7
• 作者: Mitchell, Shannon Gwin;Jester, Julia;Gryczynski, Jan;Whitter, Melanie;Fuller, Douglas;Halsted, Caroline;Schwartz, Robert P.
• 通讯作者: Schwartz, Robert P.