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

据估计，该市近10%的人口患有阿片类药物使用障碍， 2017年记录的过量死亡，费城是阿片类药物流行的城市中心， 美国的该市的阿片类药物过量死亡率最高， 全国有超过15，000个过量反应， 2017年的紧急医疗服务。尽管阿片类药物使用障碍和广泛的 基于对治疗扩展的支持，大约20%的城市药物援助 处理能力每年都得不到利用。虽然这一治疗差距是多方面确定的， 典型的筛查和登记过程中的延迟，距离治疗设施， 以及阿片类药物依赖者开始治疗的内在矛盾心理，联合收割机 作为治疗参与的重要障碍。拟议的三年努力将 评价一种新的移动的策略，用于快速启动丁丙诺啡/纳洛酮、咨询、同伴 支持和病例管理作为与长期循证用药联系的方法 辅助治疗。诱导将在个人的家庭社区启动，无论是在我们的 移动的医疗设施或通过家访。移动的小组将由执业护士（能够 开丁丙诺啡/纳洛酮在PA），并包括同行恢复专家，和一个案例 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， 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，团队将与参与者合作， 参与现有的药物辅助治疗计划。正在进行的治疗类型将 应根据个人情况确定，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洛酮（XR-NTX）。率 治疗参与和6个月时的过量将与这些参与者进行比较 从城市现有的评估和联系中心招募。详细的成本分析将 如果这一模式产生积极的结果，将为今后使用这一模式提供信息。执行 合作伙伴将是费城预防点和公共卫生管理公司。 科学支持将由宾夕法尼亚大学伤害科学中心提供， 药物使用障碍、艾滋病毒和艾滋病治疗干预的卫生经济学中心 HCV和成瘾研究中心。社区咨询委员会，由 消费者、提供者和阿片类药物使用障碍患者健康的倡导者将有助于 指导项目的实施。

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.