Reducing Opioid Mortality in Illinois (ROMI)

项目摘要 2017年，超过2700名伊利诺伊州居民死于阿片类药物过量--这个数字超过了该州 交通事故和持枪杀人案的综合死亡人数。离开监狱和监狱的人可能最多 有致命的过量用药和其他与药物有关的危害的风险。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边界的那一刻 系统，因此最容易失去后续行动和脱离服务，或有其他 基本生活需求无人照管。对于迅速流经监狱的在押人员来说，这一挑战可能最为严峻 环境，不可预测的离境阻碍出院规划和护理协调，以及司法 利益相关者可能持有诋毁物质使用或抵制减少危害干预的态度。 返回芝加哥有色人种社区的个人接近相对丰富的治疗和治疗资源 减少危害。然而，他们必须在非法毒品分销的中心地带导航，这些中心的特点特别高 海洛因、芬太尼和其他合成阿片类药物致死过量的发生率。南方的农村人 伊利诺伊州，可能距离任何美沙酮设施或任何DEA豁免的医生有很长的旅行距离 开丁丙诺啡。农村患者在提供纳洛酮和SSP时也面临地理障碍。 已经设计和实施了许多减少危害的服务，以服务于传统的 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。 我们提议的多点罗米试验(降低伊利诺伊州的阿片类药物死亡率)旨在解决这一公共卫生问题 通过改善对药物辅助治疗(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司法人员提供分配和注射器支持服务(SSP 精神错乱。我们试图测试包括同伴康复教练在内的统一案例管理方法 可以在五个不同的城乡环境中提高治疗参与度和保留率，所有人都可以体验 阿片类药物紊乱、过量用药和相关危害的高比率。 我们要求资金来实施一项五个站点的随机对照试验，招募至少1,000人 和乌德住在一起。罗米审判将使用中心辐射式模式进行，集中的长轴 社区外展干预项目(COIP)的常备社会服务基础设施 伊利诺伊大学芝加哥分校(UIC)。COIP提供案件管理/向司法过渡的护理服务- 涉及阿片类药物使用者，将资源和技术援助扩展到受影响最严重的人口较少的农村地区 受阿片类药物泛滥的影响。使用混合类型1有效性实现设计，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使用和相关 在不同的背景下造成的危害。因此，我们的务实试验处于有利地位，可以在收集 用于实施的上下文数据。

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.