Beginning Early and Assertive Treatment for Methamphetamine Use Disorder (BEAT Meth): A comprehensive systems-level secondary prevention strategy to prevent stimulant related overdoses

项目摘要 拟议研究的总体目标是评估系统级中学的有效性 预防战略，以防止兴奋剂相关的过量。2020年，丹佛42%的过量死亡 涉及甲基苯丙胺到目前为止，公共卫生系统加强联系和参与的办法， 缺乏对兴奋剂使用障碍的护理。与阿片类药物使用障碍不同，药物可以缓解症状 急性戒断和防止复发，兴奋剂使用障碍患者目前与甲基苯丙胺- 诱发精神病，通常好斗，激动，难以治疗。为了响应社区的需求， 我们丹佛健康中心的团队最近建立了一个试点项目， 甲基苯丙胺使用障碍（BEAT Meth），以制定评估和治疗 甲基苯丙胺使用障碍虽然该计划在缩短医院长度方面取得了初步成功， 住院，再入院，改善门诊成瘾治疗的后续行动， 许多患者在出院后没有继续接受护理。拟议的研究将建立在 BETH Meth通过开发、实施和评估干预措施以更好地参与 患者出院后继续接受护理。目前的应用程序是对目标1的直接响应， 疾病控制和预防中心的通知资金的机会“研究赠款发展或 确定预防涉及非法兴奋剂的药物过量和涉及 兴奋剂。”我们的多学科团队汇集了多年的经验，在物质使用的研究，过程 和结果评估，行为干预发展，成瘾医学，急诊医学， 精神病学和临床护理，以解决以下具体目标：1）进行严格的过程评估， 一项新制定的方案，用于在紧急情况下识别和治疗兴奋剂使用障碍患者，2） 制定和开展联系干预措施的过程和成果评价， 继续和参与治疗，以及3）开发系统级刺激连续护理模式 测量兴奋剂相关问题患者的进展情况和卫生系统的有效性 沿着这一连续体对患者进行治疗和干预。我们的新型公共卫生系统方法 利用公共卫生、公共安全和卫生系统之间的伙伴关系， 和有效的治疗方法。我们的发现将为一种可复制的 系统一级的干预，以提高启动率，指导治疗提供，并降低发病率和死亡率 与吸毒过量危机有关

PROJECT SUMMARY The overarching goal of the proposed research is to evaluate the effectiveness of a systems-level secondary prevention strategy to prevent stimulant related overdoses. In 2020, 42% of overdose deaths in Denver involved methamphetamine. To date, a public health systems approach to enhance linkage and engagement in care for stimulant use disorder is lacking. Unlike opioid use disorder, for which medications relieve symptoms of acute withdrawal and prevent relapse, patients with stimulant use disorder present with methamphetamine- induced psychosis and are often combative, agitated, and difficult to treat. In response to community demands, our team at Denver Health recently established a pilot program, Beginning Early and Assertive Treatment for Methamphetamine Use Disorder (BEAT Meth), to protocolize the assessment and treatment of patients with methamphetamine use disorder. While the program has shown preliminary success in reducing hospital length of stay, readmissions, and improving follow-up to outpatient addiction treatment, it has not been rigorously evaluated and many patients are not retained in care after discharge. The proposed research will build upon BETH Meth's initial success by developing, implementing, and evaluating an intervention to better engage patients into ongoing care after discharge. The current application is in direct response to Objective 1 in the Centers for Disease Control and Prevention's notice of funding opportunity for “Research Grants to Develop or Identify Effective Strategies to Prevent Overdose Involving Illicit Stimulants and Polysubstance Use Involving Stimulants.” Our multidisciplinary team brings together years of experience in substance use research, process and outcome evaluation, behavioral intervention development, addiction medicine, emergency medicine, psychiatry, and clinical care to address the following specific aims: 1) conduct a rigorous process evaluation of a newly developed protocol to identify and treat patients for stimulant use disorder in emergency settings, 2) develop and conduct process and outcomes evaluations of a linkage intervention aimed at increasing continuation and engagement in treatment, and 3) develop a systems-level stimulant continuum of care model to measure the progression of patients with stimulant-related problems and the effectiveness of health system protocols and interventions on patients along that continuum. Our novel public health systems approach leverages partnerships among public health, public safety, and health systems to provide accessible, scalable, and effective treatments for stimulant use disorder. Our findings will provide empirical evidence for a replicable systems-level intervention to increase initiation, guide treatment provision, and reduce morbidity and mortality associated with the overdose crisis.