Community-Based Intervention at Needle Exchange Sites

项目概要/摘要 社区注射器交换计划 (SEP) 参与者的注射毒品使用率 超过其他物质使用者人群中报告的数值（Wood 等人，2007 年）。我们小组之前的工作有 研究表明，结合动机和行为干预的组合方法与 美沙酮治疗登记率提高，吸毒和其他高危行为率降低 （基多夫和布鲁纳，2006）。尽管如此，SEP 的转介在美沙酮方面取得了更差的结果 与从其他来源转介的治疗相比，包括更高的药物使用率和自然损耗率（Kidorf ＆布罗纳，2006）。拟议的 5 年竞争性延续申请将我们之前的工作扩展了 评估阶梯式诱导策略，以改善注射器交换器的保留和其他结果 进入美沙酮治疗。阿片类药物依赖巴尔的摩换针 (BNEP) 参与者 (n = 520) 表示对美沙酮治疗感兴趣的人将完成临床评估组并随机进行 分配至三个为期 3 个月的治疗诱导策略之一。第一个是低阈值感应（LTSC） 该方案大致仿照美沙酮临时维持治疗（Schwartz 等人，2006 年），旨在更多 逐步将 SEP 参与者过渡到维持治疗的日常结构，同时最大限度地暴露 美沙酮药物治疗。第二种是基于代金券的干预措施，利用货币激励措施 加强治疗对美沙酮给药时间表和阶梯式咨询的参与。决赛 条件（RSC）将使参与者接受常规的分级护理。所有条件下的参与者都将获得 在参与的最后 3 个月期间进行常规逐步护理。所有参与者都将通过美沙酮稳定病情 （90 毫克），每周随访一次，持续 6 个月。将采用结构化的再入院干预措施 努力重新吸引因吸毒而离开治疗的参与者的条件（Brooner 和 Kidorf， 2002）。保留、吸毒（尿液分析和自我报告）和其他危险行为是主要结果 措施。中介模型将评估治疗准备和满意度变化的影响： 结果的预测因素。这些发现将为该领域提供基于证据的优化策略的信息 美沙酮对这一重要的注射阿片类药物使用者亚群的治疗效果。

Project Summary/Abstract Participants in community-based syringe exchange programs (SEPs) engage in rates of injection drug use that exceed those reported in other populations of substance users (Wood et al., 2007). Prior work by our group has shown that a combination approach incorporating motivational and behavioral interventions is associated with increased rates of methadone treatment enrollment and reduced rates of drug use and other high risk behaviors (Kidorf & Brooner, 2006). Neverthleless, referrals from the SEP achieved worse outcomes in methadone treatment compared to those referred from other sources, including higher rates of drug use and attrition (Kidorf & Brooner, 2006). The proposed 5-year competing continuation application extends our previous work by evaluating stepped-based induction strategies to improve retention and other outcomes of syringe exchangers entering methadone treatment. Opioid-dependent Baltimore Needle Exchange (BNEP) participants (n = 520) that express interest in methadone treatment will complete a clinical assessment battery and be randomly assigned to one of three 3-month treatment induction strategies. The first is a low threshold induction (LTSC) that is broadly modeled on interim methadone maintenance (Schwartz et al., 2006) and designed to more gradually transition SEP participants to the daily structure of maintenance treatment while maximizing exposure to methadone pharmacotherapy. The second is a voucher-based intervention that uses monetary incentives to reinforce treatment engagement to schedules of methadone dosing and stepped-based counseling. The final condition (RSC) will expose participants to routine stepped-care. Participants in all conditions will receive routine stepped care during the final 3-months of participation. All participants will be stabilized on methadone (90 mg) and followed weekly for 6-months. A structured readmission intervention will be used across conditions in efforts to re-engage participants leaving treatment in the context of drug use (Brooner & Kidorf, 2002). Retention, drug use (urinalysis and self-report), and other risk behaviors are the primary outcome measures. Mediational models will evaluate the impact of changes in treatment readiness and satisfaction as predictors of outcome. These findings will inform the field on evidenced-based strategies to optimize methadone treatment effectiveness for this important subgroup of injection opioid users.