Massachusetts Justice Community Opioid Innovation Network (JCOIN) Clinical Research Center

美国阿片类药物危机的一个主要驱动力是治疗阿片类药物使用障碍的有效药物有限 (Moud)这能减少过量用药。传统上，美国的监狱和监狱不会发起或维护Moud for 囚犯在返回社区之前患有吸毒者，这使他们面临致命过量的高风险。一个 2018年法律(第208章)使马萨诸塞州(MA)成为第一个强制要求五个县监狱交付所有 FDA批准的Mouds(缓释纳曲酮[XR-NTX]丁丙诺啡-纳洛酮[BUP-NX]，以及 美沙酮)。第208章建立了一项为期4年的试点计划，以扩大FDA批准的所有形式的Moud 五个县监狱；马萨诸塞州又有两个县监狱自愿加入这一倡议。法律规定Moud Be 在拘留前接受的个人中保持，在被判刑的囚犯中在释放前开始 在适当的情况下。这七个监狱还必须为社区继续服药提供便利 放手。马萨诸塞州司法社区阿片类药物创新网络建议与这些 七个不同的监狱和社区治疗提供者进行第一类混合有效性- 第208章的执行情况研究。我们将：(1)在以下人群中进行纵向治疗结果研究 在监狱中接受XR-NTX、BUP-NX、美沙酮或无Moud的患有OUD的囚犯利用MA的强大和 创新的公共卫生数据仓库，由20多个链接的州行政数据集组成， 检查释放后Moud的启动、接合和滞留，以及致命性和非致命性过量 和累犯。倾向评分方法将根据选择效果进行调整。(二)开展落实研究 了解促进和阻碍在监狱和社区护理中接生霉菌的背景因素 协调和最佳实践战略，以优化监狱中的穆德交付和协调护理 社区合作伙伴。(3)进行拮抗剂(XR-NTX)的中试随机比较有效性试验 在100名被判刑和随访的患者中，与释放前开始的激动剂治疗(BUP-NX或美沙酮)进行比较- 他们在释放后12个月检查无法在行政数据中评估的结果 确定程序、可接受性、可行性和效果大小，以支持未来的随机规划 比较有效性试验。(4)测算监狱实施穆德矫正制度的成本， 从国家政策制定者和社会角度进行经济评估，以比较 出狱前的穆德在匹配的对照组中没有穆德。 马萨诸塞州JCOIN团队与马萨诸塞州公共卫生部合作，将七个马萨诸塞州县监狱 和社区治疗合作伙伴，具有实现研究目标的经验和专业知识。第208章 这一倡议对司法和司法系统今后的政策和做法具有重要影响 地方、州和国家三级。这项研究对《S》第208章的执行情况的洞察将为 有效制定未来战略，以解决全国监狱人口中的死亡人数问题。

A major driver of the U.S opioid crisis is limited access to effective medications for opioid use disorder (MOUD) that reduce overdose. Traditionally, jails and prisons in the U.S. do not initiate or maintain MOUD for inmates with OUD prior to their return to the community, which places them at high risk for fatal overdose. A 2018 law (“Chapter 208”) made Massachusetts (MA) the first state to mandate that five county jails deliver all FDA-approved MOUDs (extended-release naltrexone [XR-NTX] buprenorphine-naloxone [BUP-NX], and methadone). Chapter 208 establishes a 4-year pilot program to expand all FDA-approved forms of MOUD at five county jails; two more county jails in MA voluntarily joined this initiative. The law stipulates that MOUD be maintained in individuals receiving it prior to detention, and initiated prior to release among sentenced inmates where appropriate. The seven jails must also facilitate continuation of the medication in the community on release. The Massachusetts Justice Community Opioid Innovation Network proposes to partner with these seven diverse jails and community treatment providers to conduct a Type 1 hybrid effectiveness- implementation study of Chapter 208. We will: (1) Perform a longitudinal treatment outcome study among inmates with OUD who receive XR-NTX, BUP-NX, methadone, or no MOUD in jail utilizing MA’s powerful and innovative Public Health Data Warehouse, a collection of over two dozen linked state administrative data sets, to examine post-release MOUD initiation, engagement and retention, as well as fatal and non-fatal overdose and recidivism. Propensity score methods will adjust for selection effects. (2) Conduct an implementation study to understand contextual factors that facilitate and impede delivery of MOUDs in jail and community care coordination, and best practice strategies that optimize MOUD delivery in jail and coordinated care with community partners. (3) Perform a pilot randomized comparative effectiveness trial of antagonist (XR-NTX) versus agonist treatment (BUP-NX or methadone) initiated prior to release among 100 sentenced and follow- them 12-months post-release to examine outcomes that cannot be assessed in administrative data and determine procedures, acceptability, feasibility and effect sizes to support planning for a future randomized comparative effectiveness trial. (4) Calculate the cost to the correctional system of implementing MOUD in jail, and conduct an economic evaluation from state-policymaker and societal perspectives to compare the value of MOUD prior to release from jail to no MOUD among matched controls. The Mass JCOIN team, in collaboration with the MA Department of Public Health, seven MA county jails and community treatment partners, has the experience and expertise to fulfill the study aims. The Chapter 208 initiative has important implications for future policy and practice in the justice and OUD treatment systems at the local, state, and national levels. This study’s insights into Chapter 208’s implementation will inform the efficient development of future strategies to address OUDs in jail populations nationwide.