A Rigorous Evaluation of the Opioid Intervention Court Strategy- A Public Health Response

阿片类药物过量死亡人数的急剧上升正使美国各地的社区不堪重负。这项研究将 对全国首个被称为阿片类药物干预法庭的“公共卫生法庭”进行严格评估 (OIC)模式，于2017年5月在纽约州布法罗建立。这项建议的研究目标是 评估与当地公共卫生合作实施的这一战略，以将公共卫生注入 公共安全和司法系统的反应。根据协议备忘录，申请人是完全合伙人 与纽约州伊利县卫生局代表伊利县阿片类药物流行工作组 (ECOETF)，其中包括纽约联合法院系统，第8司法区。卫生署署长 Gale Burstein博士，作为调查员全面参与，并是正在实施的ECOETF的主任 应对阿片类药物流行的战略，包括伊斯兰会议组织模式。 OIC模式是对三名毒品法庭被告在第二次服药前服药过量致死的公共卫生反应 2016年单周出庭，表明传统的毒品法庭模式(每周一次 外观)需要修改以拯救生命。OIC模式旨在让非暴力用户进入 在他们被捕后几个小时内接受治疗，而不是几周。它要求每天与法官签到，重点是 立即药物辅助治疗(MAT)和阿片类药物使用障碍治疗(公共卫生方法 为了挽救生命)，一旦情况稳定，就会将参与者转移到传统的每周毒品法庭。 值得注意的是，这种OIC模式已经成为其他地方采用这种 将公共卫生方法创新地注入到毒品法庭的反应中。然而，到目前为止，还没有 对其有效性进行了严格的评估。使用准实验研究设计，我们将比较 阿片类药物干预法庭参与者与参加 传统戒毒法庭(TDTC)。具体而言，我们将处理以下目标：目标1：治疗 影响-根据OIC和tDTC检查开始治疗的时间差异，并检查 物质使用随时间的变化(即阿片类药物使用、其他非法药物使用、酒精使用和烟草) OIC与tDTC的基础；目标2：健康影响--检查精神健康的变化(例如，症状 抑郁、心理健康造成的角色限制)和身体健康(例如，疼痛、身体上的角色限制 健康)；目标3：恢复的影响--审查社会的变化 和与复苏有关的环境因素(例如，住房稳定性、就业、社会联系)；以及 目标4：司法影响--使用法院记录审查与司法有关的结果(例如，遵守法院 对个人的任命、与毒品有关的逮捕、与毒品无关的逮捕、监禁) Vs.tDTC。这项研究的结果将回答与全国第一个公众的翻译有关的关键问题 卫生法院“，并将告知未来的做法和政策，以解决这一危机，注入公共卫生 公共安全和司法系统。

The dramatic rise in opioid overdose fatalities is overwhelming communities across the US. This study will conduct a rigorous evaluation of the nation's first “public health court” known as the Opioid Intervention Court (OIC) model that was established in Buffalo, NY, in May 2017. The research objective of this proposal is to evaluate this strategy implemented in collaboration with local public health to infuse public health into the public safety and justice system response. Under Memorandum of Agreements, the applicant is fully partnered with the Erie County, NY Department of Health on behalf of the Erie County Opioid Epidemic Task Force (ECOETF) that includes the New York Unified Court System, 8th Judicial District. The Commissioner of Health, Dr. Gale Burstein, is fully involved as an investigator and is the Director of the ECOETF that is implementing strategies to address the opioid epidemic, including the OIC model. The OIC model was a public health response to three drug court defendants fatally overdosing before their 2nd court appearance in a single week in 2016, indicating that the traditional drug court model (with weekly appearances) needed to be modified to save lives. The OIC model was designed to get non-violent users into treatment within hours of their arrest instead of weeks. It requires daily check-ins with the judge, focuses on immediate Medication Assisted Treatment (MAT) and opioid use disorder treatment (a public health approach to save lives) and once stable, transfers participants to the traditional weekly drug courts. It is important to note that this OIC model has served as a catalyst for other localities to adopt such an innovative infusion of public health approaches into the drug court response. However, to date, there has not been a rigorous evaluation of its effectiveness. Using a quasi-experimental research design, we will compare outcomes of Opioid Intervention Court participants with a comparison group of participants enrolled in a traditional Drug Treatment Court (tDTC). Specifically, we will address the following aims: Aim 1: Treatment Impact- To examine differences in time to treatment initiation on the basis of OIC vs. tDTC and to examine changes in substance use over time (i.e., opioid use, other illicit drug use, alcohol use and tobacco) on the basis of the OIC vs. tDTC; Aim 2: Health Impact- To examine changes in mental health (e.g., symptoms of depression, role limitations due to mental health) and physical health (e.g., pain, role limitations due to physical health) over time on the basis of the OIC vs. tDTC; Aim 3: Recovery Impact- To examine changes in social and environmental factors related to recovery (e.g., housing stability, employment, social connectedness); and, Aim 4: Justice Impact- To use court records to examine justice related outcomes (e.g., adherence to court appointments, drug related arrests, non-drug related arrests, incarceration) for individuals on the basis of OIC vs. tDTC. Results from this study will answer key questions related to the translation of the nation's first “public health court” and will inform future practice and policy to address this crisis by infusing public health into the public safety and justice system.