Reducing Opioid Mortality in Illinois (ROMI)

降低伊利诺伊州阿片类药物死亡率 (ROMI)

• 批准号: 9978033
• 负责人: HAROLD Alexander POLLACK
• 金额: $ 229.79万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9978033
• 关键词: Accidents; Acute; Address; Alcohol or Other Drugs use; Attitude; Buprenorphine; Caring; Case Management; Chicago; Color; Communities; Community Outreach; Control Groups; Criminal Justice; Data; Discharge Plannings; Disease; Effectiveness; Effectiveness of Interventions; Enrollment; Ensure; Evidence based treatment; Face; Fentanyl; Funding; Future; Geography; Harm Reduction; Health; Health system; Heterogeneity; Hybrids; Illinois; Imprisonment; Incidence; Individual; Infrastructure; Insurance; Intervention; Jail; Justice; Left; Mental Health Services; Methadone; Methods; Modeling; Naloxone; Narcotics; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Participant; Patients; Persons; Pharmaceutical Preparations; Physicians; Positioning Attribute; Prisons; Provider; Public Health; Randomized Controlled Trials; Recovery; Research Design; Research Personnel; Resistance; Resources; Risk; Rural; Services; Site; Social Work; Social status; Stigmatization; Syringes; System; Testing; Therapeutic; Travel; Universities; Urban Population; Visit; Woman; Work; base; buprenorphine treatment; care coordination; care systems; community partnership; cultural competence; design; effectiveness testing; experience; follow-up; gun homicide; heroin overdose; high risk; improved; medication-assisted treatment; member; men; mortality risk; opioid epidemic; opioid mortality; opioid overdose; opioid use; opioid use disorder; opioid user; peer; pragmatic trial; primary outcome; randomized trial; relapse risk; rural area; rural patients; rural setting; secondary outcome; service engagement; synthetic opioid; treatment arm; treatment group; urban setting; waiver

PROJECT ABSTRACT More than 2,700 Illinois residents died of opiate overdose in 2017—a number that surpassed the state’s combined fatalities from road accidents and gun homicide. Individuals leaving jail and prison may be at highest risk of fatal overdose and other drug-related harms. Severely vulnerable men and women face these risks at precisely the moment they cross boundaries of fragmented criminal justice, social service, and public health systems, and are thus most vulnerable to lost follow-up and disengagement from services, or to have other basic needs left unattended. The challenge may be most acute for detainees who rapidly flow through jail settings, where unpredictable departures hinder discharge planning and care coordination, and where justice stakeholders may hold attitudes that stigmatize substance use or resistant to harm reduction interventions. Individuals returning to Chicago communities of color are near relatively rich resources for both treatment and harm reduction. Yet they must navigate epicenters of illicit narcotics distribution that feature particularly high incidence of fatal overdose from heroin, fentanyl, and other synthetic opioids. Rural individuals in Southern Illinois, may have long travel distances from any methadone facility or any DEA-waivered physician available to prescribe buprenorphine. Rural patients also face geographic barriers to the provision of naloxone and SSPs. Many harm reduction services have been designed and implemented to serve urban populations in traditional centers of opioid use. The acceptability and cultural competence of such rural services remains understudied. Our proposed multi-site ROMI trial (Reducing Opioid Mortality in Illinois) seeks to address this public health challenge through improved supports and service linkages to medication-assisted treatment (MAT), naloxone distribution, and syringe support services (SSPs) provided to justice-involved individuals living with opioid use disorders. We seek to test whether a unified case management approach that includes peer recovery coaches can improve treatment engagement and retention in five diverse urban and rural contexts that all experience high rates of opioid disorders, overdose, and related harms. We request funds to implement a five-site Randomized Controlled Trial, enrolling at least 1,000 individuals living with OUD. The ROMI trial will be carried out using a hub-and-spoke model, with centralized long- standing social services infrastructure at the Community Outreach Intervention Projects (COIP) hosted at the University of Illinois at Chicago (UIC). COIP provides case management/transition of care services to justice- involved opioid users, extending resources and technical assistance to less-populated rural areas hardest-hit by the opioid epidemic. Using a hybrid type-one effectiveness implementation design, we propose a simple but effective package of treatment and harm reduction interventions to reduce subsequent opioid use and related harms in diverse contexts. Our pragmatic trial is thus well-positioned to test effectiveness while collecting contextual data for implementation.

项目摘要 2017 年，超过 2,700 名伊利诺伊州居民死于阿片类药物过量，这一数字超过了该州的死亡人数 道路交通事故和枪支凶杀造成的死亡人数合计。出狱和出狱的人可能是最高的 致命过量用药和其他与毒品相关的危害的风险。严重脆弱的男性和女性面临着这些风险 正是在他们跨越支离破碎的刑事司法、社会服务和公共卫生界限的那一刻 系统，因此最容易失去后续行动和脱离服务，或者有其他 基本需求无人照顾。对于快速出狱的被拘留者来说，这一挑战可能最为严峻 不可预测的偏离阻碍出院计划和护理协调的环境，以及正义 利益攸关方可能持有污蔑药物使用或抵制减少伤害干预措施的态度。 返回芝加哥有色人种社区的个人靠近相对丰富的治疗和治疗资源 减少伤害。然而，他们必须穿越非法麻醉品分布的中心，这些中心的特征特别高 海洛因、芬太尼和其他合成阿片类药物过量致死的发生率。南方农村人 伊利诺伊州，距离任何美沙酮机构或任何 DEA 豁免医生可能有很长的路程 开丁丙诺啡。农村患者在提供纳洛酮和过磷酸钙方面还面临地理障碍。 许多减少伤害服务的设计和实施都是为了以传统方式为城市人口提供服务 阿片类药物使用中心。这种农村服务的可接受性和文化能力仍未得到充分研究。 我们提议的多地点 ROMI 试验（降低伊利诺伊州阿片类药物死亡率）旨在解决这一公共卫生问题 通过改善药物辅助治疗（MAT）、纳洛酮的支持和服务联系来应对挑战 向使用阿片类药物的参与司法的个人提供分发和注射器支持服务 (SSP) 失调。我们寻求测试是否采用包含同伴康复教练的统一案例管理方法 可以提高所有人都经历过的五种不同城市和农村环境中的治疗参与度和保留率 阿片类药物失调、用药过量和相关危害的发生率很高。 我们请求资金实施五中心随机对照试验，招募至少 1,000 人 与 OUD 一起生活。 ROMI 试验将采用中心辐射模型进行，集中长 社区外展干预项目 (COIP) 的常设社会服务基础设施 伊利诺伊大学芝加哥分校（UIC）。 COIP 提供案件管理/将护理服务移交司法- 让阿片类药物使用者参与进来，向人口较少、受灾最严重的农村地区提供资源和技术援助 由于阿片类药物的流行。使用混合型一类有效性实施设计，我们提出了一种简单但 有效的一揽子治疗和减少伤害干预措施，以减少随后的阿片类药物和相关药物的使用 在不同的情况下都会造成伤害。因此，我们的务实试验能够很好地测试有效性，同时收集 用于实施的上下文数据。