Community-Based Intervention at Needle Exchange Sites

描述(由申请人提供)：社区注射器交换计划(SEP)的参与者参与的注射毒品使用率超过了其他药物使用者报告的比率(Wood等人，2007年)。我们小组先前的工作表明，结合动机和行为干预的组合方法与美沙酮治疗登记的增加和药物使用和其他高危行为的减少有关(Kidorf&Brooner，2006)。然而，与来自其他来源的转介相比，来自SEP的转介在美沙酮治疗中取得了更差的结果，包括更高的药物使用率和自然减少率(Kidorf&Brooner，2006)。建议的5年竞争性持续应用通过评估阶梯式诱导策略来扩展我们之前的工作，以改善进入美沙酮治疗的注射器交换器的保留率和其他结果。对美沙酮治疗表示兴趣的巴尔的摩针具交换(BNEP)参与者(n=520)将完成一组临床评估，并被随机分配到三种为期3个月的治疗诱导策略中的一种。第一种是低阈值诱导(LTSC)，它广泛模仿临时美沙酮维持(Schwartz等人，2006年)，旨在更逐步地将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于美沙酮药物治疗。第二种是基于代金券的干预，使用金钱激励来加强美沙酮剂量和循序渐进咨询计划的治疗参与度。最后一种情况(RSC)将使参与者接受常规的阶梯式护理。在参与的最后3个月期间，所有条件下的参与者都将接受常规的阶梯式护理。所有参与者都将接受美沙酮(90毫克)的稳定治疗，并每周跟踪治疗6个月。系统的再入院干预将在不同的条件下使用，以努力使离开治疗的参与者在药物使用的背景下重新参与(Brooner&Kidorf，2002)。留存、药物使用(尿检和自我报告)和其他危险行为是主要的结果衡量标准。中介模型将评估治疗准备情况和满意度变化的影响，作为结果的预测因素。这些发现将使外地了解为这一重要的注射类阿片使用者群体优化美沙酮治疗有效性的循证战略。

DESCRIPTION (provided by applicant): 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.