Developing and Testing Innovative Care Pathways for Screening and Treatment of OUD/PTSD in Jails

项目摘要 阿片类药物过量是最近从监禁中释放的人死亡的主要原因。然而， 关于监狱和监狱中阿片类药物使用障碍（OUD）和OUD药物（MOUD）的研究越来越多， 研究发现，很少有人被转介到释放后社区MOUD开始治疗。新兴 研究表明，治疗创伤后应激障碍（PTSD），一种常见的和有害的OUD， 科摩罗，可以大大增加MOUD参与的可能性;然而，这还没有经过测试 在监狱和大量的工作，首先定制创伤后应激障碍筛查和治疗监狱和人与 在这种情况下，OUD/PTSD是必需的。因此，这6年的R61/R33旨在开发和测试 创新的方法，以创伤后应激障碍筛查和治疗的人谁是有资格的监狱为基础的开放式课程 服务在R61中，我们将组建一个由社区，社区和学术利益相关者组成的联盟， 协作调整筛选，简短干预和转诊治疗模式，以适应监狱环境， 满足OUD/PTSD（SBIRT-J）囚犯的需求。在R33中，我们将1）评估实施情况 SBIRT-J通过总结性评价将OUD/PTSD监禁成人与PTSD治疗联系起来的结果 在实施研究综合框架的指导下，2）评估有效性， PTSD治疗时机的竞争模型的实施结果。为了评估后者，我们将使用 患者随机混合I型实施效果设计，其中被监禁的成年人被确定为 通过SBIRT-J模型患有OUD/PTSD的患者被随机分配到立即开始治疗 在监狱中接受创伤后应激障碍治疗或在释放后开始创伤后应激障碍治疗。我们的主要有效性结果将是后- 在从监狱释放后6个月开始释放MOUD;次要结果将包括MOUD保留， OUD严重程度，PTSD症状，受害情况和额外药物使用。有效性部分的参与者 的受试者（N = 304; 50%女性）将从阿肯色州最大的监狱入组。重要的是，我们的研究愿景 符合NIDA的战略计划，因为我们的目标是“支持研究，以扩大证据的应用- ”（目标4.3）。我们的总体目标是将研究成果 实践，以增加提供高质量的照顾，为司法参与的人与OUD，符合 美国国立卫生研究院的治愈计划的目标。事实上，这项研究将是第一个在监狱中治疗创伤后应激障碍的试验， 改善OUD结局的方法，提供PTSD作为一种新干预措施的基础信息 满足特别弱势群体需求的具体目标，并提供执行数据， 如果有效，通知迅速扩大规模。

Project Summary Opioid overdose is the leading cause of death among people recently released from incarceration. Yet, while there is growing research on opioid use disorder (OUD) and medications for OUD (MOUD) in jails and prisons, studies find that few people who are referred to post-release community MOUD initiate treatment. Emerging research suggests that therapy for posttraumatic stress disorder (PTSD), a common and deleterious OUD comorbidity, could profoundly increase the likelihood of MOUD engagement; however, this has not been tested in jails and considerable work to first tailor PTSD screening and treatment to jails and to people with OUD/PTSD in this setting would be required. Therefore, this 6-year R61/R33 aims to develop and test innovative approaches to PTSD screening and treatment among people who are eligible for jail-based OUD services. In the R61, we will form a coalition of carceral, community, and academic stakeholders to collaboratively adapt the Screening, Brief Intervention, and Referral to Treatment model to the jail context and to the needs of jailed adults with OUD/PTSD (SBIRT-J). In the R33, we will 1) assess the implementation outcomes of SBIRT-J for linking jailed adults with OUD/PTSD to therapy for PTSD via a summative evaluation guided by the Consolidated Framework for Implementation Research and 2) assess the effectiveness and implementation outcomes of competing models of PTSD therapy timing. To evaluate the latter, we will use a patient-randomized Hybrid type I implementation-effectiveness design in which jailed adults identified as having OUD/PTSD through the SBIRT-J model are randomly assigned to either immediate initiation of therapy for PTSD in jail or initiation of PTSD therapy upon release. Our primary effectiveness outcome will be post- release MOUD initiation at 6-months post-release from jail; secondary outcomes will include MOUD retention, OUD severity, PTSD symptoms, victimization, and additional drug use. Participants in the effectiveness portion of the trial (N = 304; 50% female) will be enrolled from the largest jail in Arkansas. Importantly, our study vision aligns with NIDA's Strategic Plan, as we aim to “support research to scale up the application of evidence- based interventions for SUDs, including in justice settings” (Goal 4.3). Our overall goal is to translate research to practice to increase the provision of high-quality care for justice-involved persons with OUD, consistent with the goals of NIH's HEAL Initiative. Indeed, this study will be the first trial of a treatment for PTSD in jails as a method for improving OUD outcomes, providing foundational information on PTSD as a novel intervention target for meeting the needs of a particularly vulnerable population and providing the implementation data to inform rapid scale-up if effective.