Rapid initiation of buprenorphine/naloxone to optimize MAT utilization in Philadelphia

快速启动丁丙诺啡/纳洛酮以优化费城 MAT 的利用

• 批准号: 9896726
• 负责人: DAVID S METZGER
• 金额: $ 74.62万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9896726
• 关键词: Rapid; initiation; buprenorphine; naloxone; optimize

With nearly 10% of the City’s population estimated to have an opioid use disorder and over 1200 overdose deaths recorded in 2017, Philadelphia is an urban epicenter of the opioid epidemic in the United States. The City has the highest rate of opioid overdose deaths of any of the largest cities in the country and there were more than 15,000 overdose responses made by the emergency medical services in 2017. Despite the prevalence of opioid use disorder and broad based support for treatment expansion, approximately 20% of the City’s medication assisted treatment capacity goes unused each year. While this treatment gap is multiply determined, the delays embedded in the typical screening and enrollment process, distance to treatment facilities, and the inherent ambivalence to initiate treatment among opioid dependent individuals, combine to serve as a significant barrier to treatment engagement. The proposed 3-year effort will evaluate a new, mobile strategy for rapid initiation of buprenorphine/naloxone, counseling, peer support and case management as a method for linkage to long term, evidence based medication assisted treatment. Inductions will be initiated in the individual’s home community, either on our mobile medical facility or via home visits. The mobile team will be led by a nurse practitioner (able to prescribe buprenorphine/naloxone in PA) and include a peer recovery specialist, and a case manager. The team will rapidly confirm opioid use disorder, complete informed consent, and begin induction procedures for a “transitional” (one month) course of treatment with buprenorphine/naloxone. During this time, the team will work with the participant to become engaged in existing medication assisted treatment programs. The type of ongoing treatment will be determined on an individual basis and will include options of methadone maintenance, buprenorphine/naloxone treatment, or extended release naltrexone (XR-NTX). Rates of treatment engagement and overdoses at six months will be compared to those participants recruited from the City’s existing assessment and linkage centers. A detailed cost analyses will be conducted to inform future use of this model should it produce positive results. Implementation partners will be Prevention Point Philadelphia and the Public Health Management Corporation. Scientific support will be provided by the University of Pennsylvania Injury Science Center, the Center for Health Economics of Treatment Interventions for Substance Use Disorders, HIV, and HCV and the Center for Studies of Addiction. A Community Advisory Board comprised of consumers, providers and advocates for the health of people with opioid use disorder will help to guide the implementation of the project.

据估计，该市近 10% 的人口患有阿片类药物使用障碍，超过 1200 人 2017 年记录的服药过量死亡人数，费城是阿片类药物流行病的城市中心 美国。该市的阿片类药物过量死亡率是所有最大的城市中最高的 该国的城市中，有超过 15,000 例药物过量反应 2017 年紧急医疗服务。尽管阿片类药物使用障碍普遍存在且广泛 为扩大治疗提供基础支持，该市约 20% 的药物得到援助 处理能力每年都被闲置。虽然这种治疗差距是多重确定的， 典型筛查和登记过程中存在的延误、距治疗设施的距离、 以及阿片类药物依赖个体开始治疗时固有的矛盾心理，结合 成为治疗参与的重大障碍。拟议的 3 年努力将 评估快速启动丁丙诺啡/纳洛酮的新的移动策略、咨询、同伴 支持和病例管理作为与长期循证药物联系的方法 辅助治疗。入职培训将在个人的家庭社区开始，无论是在我们的社区还是在我们的社区 流动医疗设施或通过家访。流动小组将由一名执业护士（能够 在 PA 中开出丁丙诺啡/纳洛酮）并包括一名同伴康复专家和一个病例 经理。该团队将迅速确认阿片类药物使用障碍，完成知情同意书，并 开始“过渡”（一个月）疗程的诱导程序 丁丙诺啡/纳洛酮。在此期间，团队将与参与者一起努力成为 参与现有的药物辅助治疗计划。正在进行的治疗类型将 根据个人情况确定，并将包括美沙酮维持治疗的选择， 丁丙诺啡/纳洛酮治疗，或缓释纳曲酮 (XR-NTX)。费率 六个月时的治疗参与度和用药过量情况将与这些参与者进行比较 从该市现有的评估和联系中心招募。详细的成本分析将 如果该模型产生积极的结果，则可以为该模型的未来使用提供信息。执行 合作伙伴将是费城预防点和公共卫生管理公司。 宾夕法尼亚大学损伤科学中心将提供科学支持 物质使用障碍、艾滋病毒和艾滋病治疗干预措施的卫生经济学中心 HCV 和成瘾研究中心。社区咨询委员会由以下人员组成 消费者、提供者和阿片类药物使用障碍患者健康倡导者将有助于 指导项目实施。