Data-Driven Approaches for Opioid Use Disorder Treatment, Recovery, and Overdose Prevention in Rural Communities via Mobile Health Clinics and Peer Support Services

通过移动医疗诊所和同伴支持服务在农村社区进行阿片类药物使用障碍治疗、康复和过量预防的数据驱动方法

• 批准号: 10812747
• 负责人: Alain Harris Litwin
• 金额: $ 94.26万
• 依托单位: CLEMSON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812747
• 关键词: Address; Assertiveness; Calibration; Caring; Collaborations; Communities; Data; Data Sources; Development; Disease; Drug Prescriptions; Drug usage; Effectiveness; Enrollment; Epidemic; Epidemiology; Evaluation; Exhibits; Face; Fentanyl; Goals; Hepatitis C Antibodies; Hepatitis C Therapy; Home; Homelessness; Hospitals; Individual; Insurance; Integrated Health Care Systems; Intervention; Interview; Label; Measures; Medical; Modeling; Naloxone; Opioid; Outcome; Outpatients; Overdose; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Population; Populations at Risk; Prevention; Preventive care; Protocols documentation; Randomized; Randomized, Controlled Trials; Recovery; Recurrence; Reporting; Research; Resource Allocation; Risk; Rural Community; Rural Population; Services; Social isolation; Social support; South Carolina; Specialist; Substance Use Disorder; Testing; Time; Transportation; Underserved Population; United States; Viral; Work; barrier to care; community engagement; cost; cost effectiveness; effective intervention; effectiveness evaluation; experience; fentanyl test; high risk; illicit opioid; improved; injection drug use; innovation; intervention delivery; medically underserved; medication for opioid use disorder; mobile health clinic; opioid misuse; opioid mortality; opioid overdose; opioid use; opioid use disorder; overdose death; overdose prevention; overdose risk; peer support; predictive modeling; prevent; retention rate; rural underserved; scale up; screening; service delivery; social stigma; sustainability framework; systematic review; test strip; tool; underserved community

Over 100,000 lives were lost due to drug overdose in the past year, of which 80% involved opioids. Despite the effectiveness of medications for opioid use disorder (MOUD) at reducing opioid misuse and risk of overdose, only 10% of people in need receive treatment. Moreover, treatment retention is low (30-50%) with half of patients experiencing an opioid use recurrence. Peer support specialists (PSSs), who are individuals with direct experience with and successful recovery from Substance Use Disorder, can offer social support and directly address treatment and recovery barriers for individuals with Opioid Use Disorder (OUD). Our systematic review showed that OUD patients receiving a PSS intervention were more likely to initiate MOUD, but evidence of effectiveness for MOUD retention or opioid use remain inconclusive. Low treatment initiation and retention rates for OUD are especially concerning for rural populations and underserved communities, who rarely have access to clinicians who can prescribe MOUD and experience substantial barriers to care, including limited social support, lack of insurance, homelessness, transportation issues, and stigma. Given that these populations are also at an elevated risk of opioid overdose due to many of these same factors, interventions to increase OUD treatment, retention, and overdose prevention in rural and medically underserved communities are urgently needed. Mobile health clinics (MHC) are an effective and versatile tool for timely delivery of interventions, including those for OUD treatment, to medically underserved and at-risk communities. However, effective intervention delivery for OUD treatment initiation, retention, and overdose prevention have not been explored in MHC settings. The goal of our proposal is to increase MOUD treatment initiation, treatment retention, and prevent overdose deaths in medically underserved communities (via MHC) through development, testing, delivery, and evaluation of an innovative 1) PSS intervention to increase MOUD initiation and retention rates in rural and underserved populations and 2) modeling framework to prioritize at-risk communities for MHC delivery (based on overdose deaths prevented). Research has shown that such modeling frameworks can drastically increase the efficiency of resource allocation efforts for other diseases. The PSS intervention and modeling framework will be developed in the R61 phase (R61 Aims 1 and 2) and implemented in the R33 phase to systematically deliver MHCs with PSS services to the highest priority communities (identified via modeling) in South Carolina (SC) in order to increase MOUD treatment initiation, retention, and overdose prevention. In the R33 phase, we will conduct a randomized controlled trial (RCT) to evaluate the effectiveness of the PSS intervention component (R33 Aim 1), and extend our modeling framework developed in the R61 phase in order to a) evaluate the population impact and cost-effectiveness of the PSS intervention on preventing fatal overdose (R33 Aim 2a) and b) explore improvements to MHC protocols in order to increase effectiveness of MHC-based interventions for OUD (R33 Aim 2b). With opioid overdose deaths doubling over the past 2 years nationally and in SC, there are no signs that the epidemic is slowing down. Our sustainable framework has potential to prevent hundreds to thousands of opioid overdoses in SC alone, and can be scaled up in other regions to save many more lives.

在过去的一年中，由于药物过量而丧生了100,000多人，其中80％涉及阿片类药物。尽管有 药物对阿片类药物使用障碍（MOUD）的有效性在减少阿片类药物滥用和过量风险方面，只有10％ 有需要的人接受治疗。此外，治疗保留率很低（30-50％），一半的患者患有 阿片类药物使用复发。同伴支持专家（PSSS），他们是具有直接经验并成功的个人 从药物使用障碍中恢复，可以提供社会支持并直接解决治疗和恢复障碍 患有阿片类药物使用障碍的人（OUD）。我们的系统评价表明，OUD患者接受了PSS 干预更有可能引发moud，但是保留效率或使用阿片类药物有效性的证据仍然存在 尚无定论。 OUD的低治疗开始和保留率尤其与农村人口有关 服务不足的社区，他们很少能与可以开处方穆德并体验丰富的临床医生。 护理障碍，包括社会支持有限，缺乏保险，无家可归，交通问题和污名。给出 由于许多相同的因素，干预措施 迫切需要增加农村和医学贫困社区中的OUD治疗，保留和预防过量的治疗方法 需要。移动健康诊所（MHC）是及时提供干预措施的有效且多才多艺的工具，包括 那些接受医学贫困和处于危险的社区的OUD治疗。但是，有效的干预交付 在MHC环境中尚未探索OUD治疗启动，保留和预防过量。我们的目标 提案是增加MOUD治疗开始，治疗保留率，并预防医学上的过量死亡 通过开发，测试，交付和评估创新的社区（通过MHC）（通过MHC）1）PSS 干预措施以增加农村和服务不足人群中的MOUD启动和保留率，以及2）建模 框架以优先考虑MHC交付的高危社区（基于预防过量的死亡）。研究表明 这样的建模框架可以大大提高其他疾病的资源分配效率。这 PSS干预和建模框架将在R61阶段开发（R61 AIMS 1和2），并在 R33阶段系统地将带有PSS服务的MHC运送到最高优先级社区（通过 在南卡罗来纳州（SC）进行建模），以增加MOUD治疗启动，保留和预防过量。在 R33阶段，我们将进行一项随机对照试验（RCT），以评估PSS干预的有效性 组件（R33 AIM 1），并扩展我们在R61阶段开发的建模框架以a）评估 PSS干预对预防致命过量的人群影响和成本效益（R33 AIM 2A）和B） 探索对MHC协议的改进，以提高基于MHC的OUD干预措施的有效性（R33 目标2b）。在过去的两年中，阿片类药物过量死亡人数增加了一倍，在SC中，没有任何迹象表明 流行病正在减慢。我们的可持续框架有可能预防数百万至数千种阿片类药物过量 仅在SC中，可以在其他地区进行扩展，以挽救更多的生命。