Counteracting Structural Barriers to Increase Access to Medications for Opioid Use Disorder (MOUD) Among Unhoused Montanans

消除结构性障碍，增加无家可归的蒙大拿人获得阿片类药物使用障碍 (MOUD) 药物的机会

• 批准号: 10773710
• 负责人: Rebecca Ramos
• 金额: $ 112.42万
• 依托单位: OPEN AID ALLIANCE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-22 至 2028-09-21
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10773710
• 关键词: Caring; Chronic; Client; County; Death Rate; Diagnosis; Education; Equity; Evidence based intervention; General Population; Health; Health Occupations; Health Personnel; Health Services Accessibility; Homelessness; Indian reservation; Individual; Intervention; Measures; Medicaid; Modeling; Monitor; Montana; Needle-Exchange Programs; Nurses; Outcome; Overdose; Patients; Persons; Population; Rural; Self Efficacy; Site; Specialist; Stigmatization; Substance Use Disorder; Time; Trauma; Trust; Underserved Population; barrier to care; care systems; clinical training; combat; experience; geographic difference; innovation; medication for opioid use disorder; opioid epidemic; opioid mortality; opioid overdose; opioid use; opioid use disorder; overdose death; patient oriented; peer; prescription opioid; prevent; primary outcome; reduced substance use; rural area; service programs; structural determinants; urban area; willingness

The opioid epidemic has disproportionately impacted the unhoused population with an overdose death rate 20 times higher than that of the general population. Medications for opioid use disorder (MOUD) is highly effective in saving lives, but unhoused individuals experience many structural barriers to accessing treatment – stigmatization by healthcare providers, limited acceptance of Medicaid, and personal instability that precludes treatment co-requirements. Those barriers are compounded for unhoused individuals in Montana (MT) where the number of Montanans with opioid use disorder (OUD) outweigh treatment capacity by 10-fold with 92% of individuals with OUD (housed and unhoused) not receiving treatment. To combat these barriers, we will utilize three evidence-based interventions proven to increase engagement of underserved populations: 1) MOUD care based in syringe service programs (SSPs), 2) a nurse-led model of MOUD, and 3) peer navigator supported care. We will embed these interventions into the five SSPs that span the state of MT – sites located in both urban and rural areas with three sites adjacent to American Indian Reservations. Following the OUD cascade of care framework, we will assess the following measures among SSP clients: 1) engaged in care services at SSP, 2) OUD diagnosis by SSP prescriber, 3) MOUD initiations, 4) patient days on MOUD, and 5) MOUD for ≥ 60 days, 90 days, and 180 days. In each SSP, we aim to surpass the state average of Montanans utilizing MOUD. In whole, we intend to make these SSPs the state model for equitable OUD care.

阿片类药物的流行对无住房人口造成了不成比例的影响，导致过量死亡