Implementation of Mobile Medication Units for Patients with Opioid Use Disorder in New York.

项目总结 项目概述：美沙酮是被批准用于治疗阿片使用障碍(OUD)的最古老的药物， 对于许多患者来说，这是控制症状和降低过量用药风险的最佳治疗方法。因为它的 美沙酮于1972年获得批准，几乎完全通过严格监管的阿片类药物治疗来分配 在固定位置运行的程序(OTP)。然而，在2021年6月，美国禁毒署 政府发布了一项规则，允许OTP创建移动治疗，从而扩大美沙酮的使用范围 现有登记的单位(配备安全配药的机动车辆)。鼓励移动 美沙酮的实施，纽约成瘾服务和支持办公室在全州范围内发起了 试点赠款计划，以支持创建流动美沙酮，并选择了最初的13名受赠者。 流动美沙酮有可能将美沙酮的使用和其他服务(例如咨询)扩大到 那些原本需要长途跋涉或经历挑战的人 程序。该项目将审查纽约试点方案的执行情况，目的是向 在全国范围内持续服药过量期间在其他州实施类似计划的可行性和范围 危机。这与NIDA的目标一致，即增加研究和开发对公共健康的影响 治疗的新方法。目标1建议研究推出移动项目的障碍和促进者 在试点OTP及其社区合作伙伴中。半结构化面试(N=40)将在以下人员中进行 来自试点OTPS合作伙伴组织的工作人员，这些组织为当地试点站点的OUD患者提供服务 社区，如社会服务机构和减少伤害组织。采访将探索 在试点社区中形成单元早期实施的机会和限制。目标2 探讨现有和潜在患者接受移动服务的需求和偏好。一个 调查将在患有OUD(N=160)的人中进行：80名当前流动美沙酮患者和80名 OUD目前没有使用任何移动服务。问题将检查对护理、个人服务的偏好 需求，以及以前接受护理的经历。Aim 3开发了一个位置模拟工具来通知选择 移动单元的治疗停靠点。使用该州的索赔数据来确定当前和潜在的位置 移动美沙酮客户端(诊断为OUD的人)将被映射到实体 OTP。使用地理空间聚类方法，我们将确定该州服务和服务需求未得到满足的地区 开发了一种选择OTP行驶距离内的移动服务区域的模拟方法 并预测可能在这些单元接受护理的患者数量。该项目将包括 在纽约与利益攸关方定期举行情况通报会，其中包括南美洲国家组织的工作人员和试点受赠人。研究将提供信息 未来的R01，以评估纽约计划对获得和过量用药的长期影响。

PROJECT SUMMARY Project Summary: Methadone is the oldest approved medication for treating opioid use disorder (OUD) and, for many patients, it is the optimal treatment for managing symptoms and reducing overdose risk. Since its approval in 1972, methadone has been dispensed nearly exclusively through highly regulated opioid treatment programs (OTPs), operating in fixed locations. In June 2021, however, the US Drug Enforcement Administration released a rule expanding methadone access by allowing OTPs to create mobile treatment units (motor vehicles equipped with secure dispensing) under their existing registration. To encourage mobile methadone implementation, the New York Office of Addiction Services and Supports launched a statewide pilot grant program to support the creation of mobile methadone and selected an initial thirteen grantees. Mobile methadone has the potential to expand methadone access and other services (e.g., counseling) to people who otherwise would need to travel long distances or experience challenges reaching traditional programs. This project will examine implementation of the New York pilot program with the goal of informing the feasibility and scope of implementing similar programs in other states during an ongoing national overdose crisis. This is consistent with the NIDA goals of increasing the public health impact of research and developing novel approaches to treatment. Aim 1 proposes to study barriers and facilitators to launching mobile programs among pilot OTPs and their community partners. Semi-structured interviews (N=40) will be conducted with staff members from pilot OTPs partner organizations that serve people with OUD in the local pilot site communities, such as social service agencies and harm reduction organizations. Interviews will explore opportunities and constraints that shape the early implementation of units in pilot site communities. Aim 2 explores the need and preferences for receiving mobile services among current and potential patients. A survey will be fielded with people with OUD (N=160): 80 current mobile methadone patients and 80 people with OUD not currently using any mobile services. Questions will examine preferences for care, individual service needs, and prior experiences receiving care. Aim 3 develops a location simulation tool to inform the selection of treatment stops for mobile units. Using claims data from the state the locations of current and potential mobile methadone clients (people with diagnosed OUD) will be mapped in relation to the brick-and-mortar OTPs. Using geospatial clustering methods, we will identify areas in the state with unmet need for services and develop a simulation approach for selecting areas within driving distance of the OTP to be served by mobile units, and predict the likely number of patients who would receive care at the units. The project will include regular briefings with stakeholders in New York, including OASAS staff and pilot grantees. Research will inform a future R01 to evaluate the longer-term impact of the New York program on access and overdose.