Facilitating Opioid Care Connections: System level strategies to improve use of MAT and movement through the opioid care cascade for defendants in a new Opioid Court system

在全国阿片类药物流行的背景下，阿片类药物使用率(OU)、阿片使用障碍(OUD)和过量 (OD)对司法系统人员的影响不成比例。然而，尽管OU和OUD的比率如此之高，筛查 对于OU和OUD的循证治疗，包括治疗OUD(Moud)的药物，有 在司法人群中的使用严重不足。法院是司法系统的理想干预点 确定OU或OUD和OOD风险，并将被告与社区中的治疗/Moud联系起来。然而，不到 5%的有毒品问题的被告得到了戒毒法庭的服务。应对阿片类药物危机 纽约州(NYS)，提议的项目将在那里进行，统一法院系统(UCS)制定了 新的治疗法庭模式-阿片法庭模式(OCM)-设计了大约10个实践指南来解决 通过快速筛查和与Moud的联系，消除现有毒品法庭的缺陷，减少吸毒、吸毒和累犯率。 2018年，纽约开始将OCM扩展到纽约的9个初始采用者县。然而，考虑到创新 在拥有一系列资源的不同国家实施的确切障碍--以及 克服它们的策略-在很大程度上是未知的。我们建议将循证实施 改进和评估OCM Rise的战略，这是一种实施干预措施，将允许OCM按照框架 根据10项实践指南，将在整个纽约推广。这份UG1建议书来自三个PI， 在司法系统、执行科学和制定治疗方法方面的免费专业知识 它在社区环境中交付，并得到强大的多学科团队的支持，以实现研究目标。 以探索准备实施可持续(EPIS)模型和社会认知理论为指导 (SCT)，具体目标是：1)通过与满足以下条件的“初始采用者”县开展形成性工作，完善OCM Rise 通过记录OCM/阿片类药物级联结果确定服务提供方面的差距；(B)确定 在实施准则方面的成功/挑战；以及(C)说明 县阿片类药物法庭和治疗系统。2)。在10个新县的阶梯形楔形设计中 基线治疗照常(毒品法庭)，以测试：(A)OCM的执行影响在改进中上升 阿片类药物级联的实施成果(筛查/鉴定、转诊、治疗登记、 (B)OCM在改善公共卫生(治疗)方面的临床和成本效益上升 拘留/法庭毕业)和公共安全(累犯)结果，探索主持人：被告性别， 年龄、收费；县城市化程度和县OD率。3)描述和比较通过 OCM在10个新采用县的实施阶段，阐明了内部和外部的EPIS- 和小规模技术衍生的影响执行战略交付的因素，以告知海洋和海洋管理组织扩大规模；和(B) 探索实施阶段完成与所有阿片类药物级联、公共卫生和 公共安全成果。

In the context of a nationwide opioid epidemic, rates of opioid use (OU), opioid use disorder (OUD) and overdose (OD) disproportionately affect those in the justice system. Yet despite such high rates of OU and OUD, screening for and use of evidence-based treatments for OU and OUD, including medication to treat OUD (MOUD), are substantially underused in justice populations. Courts are an ideal point of intervention in the justice system to identify OU or OUD, and OD risk, and link defendants to treatment/MOUD in the community. However, less than 5% of defendants with drug problems are served by drug treatment courts. In response to the opioid crisis in New York State (NYS), where the propose project will take place, the Unified Court System (UCS) developed a new treatment court model – the opioid court model (OCM) - designed around 10 practice guidelines to address the flaws of existing drug courts and reduce OD, OUD, and recidivism via rapid screening and linkage to MOUD. In 2018, NYS began to expand the OCM across NYS with 9 “initial adopter” counties. Yet, given the innovation of the OCM, the exact barriers to implementation in disparate counties with a range of resources – and the strategies to overcome them – are largely unknown. We propose to integrate evidence-based implementation strategies to refine and evaluate OCM RISE, an implementation intervention that will allow the OCM, as framed by the 10 practice guidelines, to be scaled up across NYS. This UG1 proposal is from three PIs with complimentary expertise in the justice system, implementation science and developing treatment for OUD and its delivery in community settings, and is supported by a strong multi-disciplinary team to achieve study aims. Guided by Exploration Preparation Implementation Sustainment (EPIS) model and Social Cognitive Theory (SCT), Specific Aims are: 1) To refine OCM RISE using formative work with “initial adopter” counties that (a) identifies gaps in service provision by documenting OCM/opioid cascade outcomes; (b) identifies successes/challenges in operationalizing guidelines; and (c) characterizes the working relationships between county opioid court and treatment systems. 2). In a stepped-wedge design in 10 new counties compared to baseline treatment as usual (drug courts), to test, (a) the implementation impact of OCM RISE in improving implementation outcomes along the opioid cascade (screening/identification, referral, treatment enrollment, MOUD initiation); and (b) the clinical and cost effectiveness of OCM RISE in improving public health (treatment retention/court graduation) and public safety (recidivism) outcomes, exploring moderators: defendant gender, age, charge; county urbanicity and county OD rates. 3) To characterize and compare advancement through the stages of implementation of the OCM in the 10 new adopter counties, elucidating the inner- and outer-level EPIS- and SCT-derived factors that influence delivery of implementation strategies to inform OCM scale up; and (b) to explore the relationship between implementation stage completion and all opioid cascade, public health and public safety outcomes.