Community-Based Intervention at Needle Exchange Sites

项目总结/摘要 社区注射器交换计划（SEP）的参与者参与注射毒品使用率， 超过了其他药物使用者群体中报告的水平（Wood等人，2007年）。我们小组之前的工作 表明，结合动机和行为干预的组合方法与 增加美沙酮治疗登记率，减少吸毒率和其他高危行为 （Kidorf & Brooner，2006年）。毫无疑问，SEP的转诊在美沙酮方面取得了更差的结果 治疗相比，从其他来源，包括更高的药物使用率和磨损（Kidorf & Brooner，2006）。拟议的5年竞争延续申请扩展了我们以前的工作， 评估基于阶梯式的诱导策略，以改善注射器交换器的保留和其他结果 接受美沙酮治疗阿片类药物依赖性巴尔的摩针头交换（BNEP）参与者（n = 520） 表示对美沙酮治疗感兴趣的人将完成一系列临床评估， 分配至三种3个月治疗诱导策略之一。第一种是低阈值诱导（LTSC） 其广泛地以临时美沙酮维持为模型（Schwartz等人，2006年），旨在 逐步将SEP参与者过渡到维持治疗的日常结构，同时最大化暴露 美沙酮药物治疗第二种是基于凭证的干预，使用货币激励， 加强美沙酮给药和逐步咨询的治疗参与。最终 条件（RSC）将使参与者接受常规分步护理。所有条件下的参与者将获得 在参与的最后3个月期间进行常规阶梯式护理。所有参与者将稳定美沙酮 (90 mg），每周随访6个月。结构化再入院干预将用于 在努力重新吸引在吸毒情况下离开治疗的参与者方面的条件（Brooner & Kidorf， 2002年）。尿潴留、药物使用（尿分析和自我报告）和其他危险行为是主要结局 措施中介模型将评估治疗准备和满意度变化的影响， 预测结果。这些调查结果将为实地提供基于证据的战略， 美沙酮治疗对这一重要的注射阿片类药物使用者亚组的有效性。

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.