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

项目总结 拟议研究的首要目标是评估系统级辅助系统的有效性。 预防策略，防止兴奋剂相关的过量使用。2020年，丹佛市42%的过量死亡病例 涉及甲基苯丙胺。到目前为止，公共卫生系统采取了一种方法，以加强在 缺乏对兴奋剂使用障碍的关注。与阿片类药物使用障碍不同，药物可以缓解症状 急性戒断和预防复发，兴奋剂使用障碍患者出现冰毒- 诱发性精神错乱，通常是好斗、激动和难以治疗的。为回应社会需求， 我们在丹佛健康的团队最近建立了一个试点计划，开始早期和自信的治疗 甲基苯丙胺使用障碍(Beat Meth)，将患者的评估和治疗程序化 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 在住院、再入院和改善门诊成瘾治疗的随访方面，它并不严格 经过评估，许多患者在出院后不再接受护理。拟议的研究将建立在 贝丝·梅斯通过制定、实施和评估干预措施以更好地参与其中而取得的初步成功 患者出院后进入持续护理。当前应用程序直接响应 美国疾病预防控制中心关于“研究经费用于开发或控制疾病”的通知 确定有效战略，防止涉及非法兴奋剂的过量使用和涉及的多物质使用 兴奋剂。“我们的多学科团队汇集了多年的物质使用研究、工艺 结果评估，行为干预发展，成瘾医学，急救医学， 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 一种新开发的方案，用于在紧急情况下识别和治疗兴奋剂使用障碍患者，2) 制定和进行联动干预的过程和结果评估，旨在提高 继续和参与治疗，以及3)发展系统级的刺激性连续护理模式 衡量兴奋剂相关问题患者的进展和卫生系统的有效性 在这一连续体上对患者进行治疗方案和干预。我们新的公共卫生系统方法 利用公共卫生、公共安全和卫生系统之间的合作伙伴关系，提供可访问、可扩展 以及对兴奋剂使用障碍的有效治疗。我们的发现将为可复制的 系统一级干预，以增加启动、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.