Using SMART Design to Identify an Effective and Cost-Beneficial Approach to Preventing OUD in Justice-Involved Youth

摘要/摘要 参与法律制度的青年是一个易受伤害的群体，吸毒率很高， 服药过量。由于强制禁欲和随之而来的较低的耐受率，过量服药的风险是50倍 被监禁的人在获释后的头两周比一般人高。全国范围内， 与非法生产的芬太尼和其他合成阿片类药物的频率上升相称，青少年 服药过量的风险正在急剧增加。风险因素也在发生变化。在此之前，事先使用高效的 阿片类药物和阿片类药物或多物质使用障碍是青少年/青年吸毒过量的关键危险因素。 目前，致命性过量的青年中只有三分之一以前使用过阿片类药物。在华盛顿州 年，儿童、青年和家庭部少年康复系统几乎每3名青年中就有1人 我们的国营设施符合阿片类药物使用障碍的条件，58%的年轻人接受了药物使用筛查 精神障碍表明，他们在过去的某个时候服用了过量的药物，而不是致命的。我们试图进行一场混合的 方法对YILS可改变的过量用药危险因素进行三角识别研究，制定策略 衡量这一风险，并开发和测试多级干预措施以降低这一风险。我们预计会有一个 将教育、行之有效的减害策略和提高行为动机的策略结合起来 将是减少被监禁青年服药过量风险的最有效方法。尽管这项提议是 针对特定的高危人群(被监禁青年)，我们将制定预防服药过量的策略 这可以在其他人群中复制，解决我们国家最关键的公共卫生问题之一。 在目标1中，我们将对接触过量药物的青少年进行定性的个人半结构化访谈。 (20-30人)；内部利益攸关方，如工作人员和医务人员(10-15人)；外部利益攸关方 研究或政策专长(5-10人)。在目标2中，我们将对行政部门进行横断面评估 DCYF JR数据，以确定与先前过量事件相关的可修改的风险降低因素。在《目标3》中我们 将根据先前的目标制定多层次的预防性干预数据。我们预计将包括教育 活动/倡议、纳洛酮和芬太尼试纸分发、激励性访谈以开发 预防服药过量的目标和增强实现这些目标的动力，以及短信提醒 组件。我们将与20个DCYF Jr一起测试需要改进的干预的特定组件 青年，期待未来的随机对照试验(RCT)。最后，我们将探讨数据链接 DCYF JR和其他管理数据系统之间的关系，以确定是否可以预测 系统(S)经历致命或接近致命过量的年轻人最有可能在2 在服药过量前几个月。这项提议与NIDA的Hear倡议和战略计划相一致，并 将降低我国最脆弱的年轻人服药过量的风险。

SUMMARY/ABSTRACT Youth involved in legal systems (YILS) are a vulnerable population with high rates of substance use and overdose. Due to forced abstinence and consequent lower tolerance rates, the risk of overdose is 50 times higher for incarcerated persons than the general population in the first two weeks after release. Nationally, commensurate with the rise in frequency of illicitly produced fentanyl and other synthetic opioids, adolescent overdose risk is increasing dramatically. Risk factors are also changing. Previously, prior use of highly potent opioids and opioid or polysubstance use disorder were critical risk factors for adolescent/young adult overdose. Currently only one in three youth that fatally overdoses has used opioids previously. In the Washington State Department of Children, Youth, and Families Juvenile Rehabilitation (DCYF JR) system almost 1 in 3 youth in our state-run facilities qualify as having opioid use disorder, and 58% of youth screened for substance use disorders indicate that they have overdosed non-fatally at some point in the past. We seek to conduct a mixed methods study to triangulate identification of modifiable overdose risk factors for YILS, develop strategies to measure this risk, and develop and test a multilevel intervention to reduce this risk. We anticipate that a combination of education, proven harm reduction strategies, and strategies to increase behavioral motivation will be the most effective way to reduce overdose risk amongst incarcerated youth. Although this proposal is focused on a specific high-risk population (incarcerated youth), we will develop overdose prevention strategies that can be replicated in other populations, addressing one of our nation's most critical public health concerns. In Aim 1 we will conduct qualitative individual semi-structured interviews with youth with exposure to overdose (20-30); internal stakeholders such as staff and medical personnel (10-15); and external stakeholders with research or policy expertise (5-10). In Aim 2 we will conduct a cross-sectional assessment of administrative DCYF JR data to identify modifiable risk reduction factors associated with prior overdose event. In Aim 3 we will develop multilevel preventive intervention data from prior aims. We anticipate including educational campaigns/initiatives, naloxone and fentanyl test strip distribution, motivational interviewing to develop overdose prevention goals and enhance motivation to carry out these goals, and text messaging reminder components. We will test specific components of the intervention in need of refinement with 20 DCYF JR youth, in anticipation of a future randomized controlled trial (RCT). Finally, we will explore data linkages between DCYF JR and other administrative data systems to determine if it is possible to predict which system(s) youth experiencing fatal or near fatal overdose are most likely to have interacted with in the 2 months prior to the overdose event. This proposal is aligned with NIDA's HEAL initiative and strategic plan and will reduce overdose risk among our nation's most vulnerable youth.