Facilitating Opioid Care Connections: System level strategies to improve use of MAT and movement through the opioid care cascade for defendants in a new Opioid Court system

在全国范围内阿片类药物流行的背景下，阿片类药物使用率、阿片类药物使用障碍率和药物过量率 (OD)对司法系统中的人产生了不成比例的影响。然而，尽管如此高的发病率， 针对OUD和OUD的循证治疗，包括治疗OUD的药物（MOUD）， 在司法人口中的使用严重不足。法院是司法系统的理想干预点， 确定吸毒或吸毒过量和吸毒过量风险，并将被告与社区的治疗/MOUD联系起来。然而，少于 5%有毒品问题的被告接受戒毒治疗法庭的服务。为了应对阿片类药物危机， 纽约州（NYS），在那里提出的项目将发生，统一法院系统（UCS）开发了一个 新的治疗法庭模式-阿片类药物法庭模式（OCM）-设计了大约10个实践指南，以解决 现有毒品法庭的缺陷，并通过快速筛查和与MOUD的联系减少OD，OUD和累犯。 2018年，纽约州开始将OCM扩展到纽约州的9个“初始采用者”县。然而，鉴于创新 OCM，在拥有各种资源的不同国家实施的确切障碍-以及 克服这些问题的战略在很大程度上是未知的。我们建议将循证实施纳入 完善和评估OCM RISE的战略，这是一项实施干预措施， 通过10个实践指南，将在纽约州推广。该UG 1提案来自三个PI， 在司法系统，实施科学和开发治疗OUD和 它在社区环境中提供，并得到一个强大的跨学科团队的支持，以实现研究目标。 以探索、准备、实施和支持（EPIS）模型和社会认知理论为指导 (SCT)具体目标是：1）利用与“初始采用者”县的形成性工作来完善OCM RISE， 通过记录OCM/阿片类级联结果，确定服务提供方面的差距;（B）确定 在实施准则方面的成功/挑战;以及（c）说明 县阿片类药物法庭和治疗系统。2）。在10个新县的阶梯楔形设计中， 基线治疗照常（毒品法庭），以测试，（a）OCM RISE在改善 实施结果沿着阿片类级联反应（筛选/鉴定，转诊，治疗登记， MOUD启动）;以及（B）OCM RISE在改善公共卫生（治疗）方面的临床和成本效益 保留/法院毕业）和公共安全（累犯）的结果，探索主持人：被告性别， 年龄，费用;县城市化和县OD率。3)描述和比较 OCM在10个新采用县的实施阶段，阐明内部和外部层面的EPIS- 以及影响实施战略交付的SCT衍生因素，以告知OCM规模扩大;以及（B） 探讨完成执行阶段与所有类阿片级联、公共卫生和 公共安全成果。

In the context of a nationwide opioid epidemic, rates of opioid use (OU), opioid use disorder (OUD) and overdose (OD) disproportionately affect those in the justice system. Yet despite such high rates of OU and OUD, screening for and use of evidence-based treatments for OU and OUD, including medication to treat OUD (MOUD), are substantially underused in justice populations. Courts are an ideal point of intervention in the justice system to identify OU or OUD, and OD risk, and link defendants to treatment/MOUD in the community. However, less than 5% of defendants with drug problems are served by drug treatment courts. In response to the opioid crisis in New York State (NYS), where the propose project will take place, the Unified Court System (UCS) developed a new treatment court model – the opioid court model (OCM) - designed around 10 practice guidelines to address the flaws of existing drug courts and reduce OD, OUD, and recidivism via rapid screening and linkage to MOUD. In 2018, NYS began to expand the OCM across NYS with 9 “initial adopter” counties. Yet, given the innovation of the OCM, the exact barriers to implementation in disparate counties with a range of resources – and the strategies to overcome them – are largely unknown. We propose to integrate evidence-based implementation strategies to refine and evaluate OCM RISE, an implementation intervention that will allow the OCM, as framed by the 10 practice guidelines, to be scaled up across NYS. This UG1 proposal is from three PIs with complimentary expertise in the justice system, implementation science and developing treatment for OUD and its delivery in community settings, and is supported by a strong multi-disciplinary team to achieve study aims. Guided by Exploration Preparation Implementation Sustainment (EPIS) model and Social Cognitive Theory (SCT), Specific Aims are: 1) To refine OCM RISE using formative work with “initial adopter” counties that (a) identifies gaps in service provision by documenting OCM/opioid cascade outcomes; (b) identifies successes/challenges in operationalizing guidelines; and (c) characterizes the working relationships between county opioid court and treatment systems. 2). In a stepped-wedge design in 10 new counties compared to baseline treatment as usual (drug courts), to test, (a) the implementation impact of OCM RISE in improving implementation outcomes along the opioid cascade (screening/identification, referral, treatment enrollment, MOUD initiation); and (b) the clinical and cost effectiveness of OCM RISE in improving public health (treatment retention/court graduation) and public safety (recidivism) outcomes, exploring moderators: defendant gender, age, charge; county urbanicity and county OD rates. 3) To characterize and compare advancement through the stages of implementation of the OCM in the 10 new adopter counties, elucidating the inner- and outer-level EPIS- and SCT-derived factors that influence delivery of implementation strategies to inform OCM scale up; and (b) to explore the relationship between implementation stage completion and all opioid cascade, public health and public safety outcomes.