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

点击翻译按钮获取中文摘要

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.