Linkage navigation to enhance initiation and engagement in treatment for opioid use disorder to prevent overdose.

项目总结 拟议研究的总体目标是开发、试验和评估链接导航计划 加强阿片类药物使用障碍(OUD)治疗的启动和参与，以防止过量用药。到目前为止， 支持确定并将OUD患者与治疗联系起来的策略的经验证据很少。其中之一 最有希望的策略包括启动在急诊科(ED)环境下确定的患者 丁丙诺啡，然后转介他们在初级保健中进行治疗。然而，这种干预是 依赖于患者在向急诊室或急诊室报告时表现出中到重度阿片类药物戒断迹象 给病人注射丁丙诺啡进行自我诱导。干预也取决于忙碌的边缘 参与正在进行的治疗的诱导和转介过程的提供者。在最初的试验中，转介到 治疗包括与一名研究助理进行10至15分钟的简短谈判采访。另一种选择， 也许更可持续的方法可以是将这种联系应用于护理模式，从艾滋病毒预防到 使用侧重于以下方面的干预措施促进识别和将OUD患者与治疗联系起来 转诊至治疗部分，无论他们是否被诱导使用丁丙诺啡 艾德。鉴于2017年全国因阿片类药物过量而就诊的急诊率增加了30%，有针对性的干预措施 在急诊室是必不可少的。我们的多学科团队汇集了多年的物质使用经验 研究，急诊医学，干预发展和评估，成瘾医学，患者 导航和临床护理解决以下具体目标：1)制定干预措施，以增强 与阿片类药物使用障碍患者的启动和参与治疗的联系以及2)评估 一项干预措施的可接受性、可行性和初步效果，以加强与启动和保留的联系 与单独的临床医生转诊相比，阿片类药物使用障碍的个人治疗加临床医生转诊。 鉴于HIV和OUD之间的相似之处，我们将采用循证抗逆转录病毒治疗和 获得服务(ARTAS)议定书，以加强个人与OUD到阿片类激动剂治疗的联系。 我们将进行定性研究，包括关键线人采访滥用阿片类药物的人， 治疗和临床提供者，以及患者导航员，以告知对ARTAS的必要修改 有必要加强与OUD治疗中的启动和保留的联系。信息来自 采访将补充先前的文献和其他以证据为基础的模型，以最终确定试点 干预。我们将在中到重度阿片类药物使用障碍患者中试行已开发的干预措施 他们目前没有在接受治疗。我们将从丹佛健康教育中心招募108名参与者，以比较 干预(n=58)到护理标准(n=58)，采用区组随机设计。我们的主要结果将是 随机化后30天内开始治疗，次要结果包括治疗 一个月和三个月的参与度、阿片类药物使用天数、非致命性过量和致命性过量。

PROJECT SUMMARY The overarching goal of the proposed research is to develop, pilot, and evaluate a linkage navigation program to enhance initiation and engagement in treatment for opioid use disorder (OUD) to prevent overdose. To date, empirical evidence to support strategies to identify and link individuals with OUD to treatment is sparse. One of the most promising strategies involves initiating patients identified in emergency department (ED) settings onto buprenorphine, then referring them for ongoing treatment in primary care. However, this intervention is dependent on patients exhibiting signs of moderate to severe opioid withdrawal when they present to the ED or discharging the patient with buprenorphine for self-induction. The intervention is also dependent on busy ED providers engaging in the process of induction and referral for ongoing treatment. In the initial trial, referral to treatment consisted of a 10 to 15 minute brief negotiation interview with a research associate. An alternative, and perhaps more sustainable, approach could be to apply the linkage to care models from HIV prevention to facilitate identification and linkage of individuals with OUD to treatment using an intervention that focuses on the referral to treatment component, irrespective of whether or not they are inducted onto buprenorphine in the ED. Given the 30% increase in ED visits for opioid overdose across the country in 2017, targeting interventions in the ED is essential. Our multidisciplinary team brings together years of experience in substance use research, emergency medicine, intervention development and evaluation, addiction medicine, patient navigation, and clinical care to address the following specific aims: 1) To develop an intervention to enhance linkage to initiation and engagement in treatment for individuals with opioid use disorder and 2) To assess acceptability, feasibility, and initial efficacy of an intervention to enhance linkage to initiation and retention in treatment for individuals with opioid use disorder plus clinician referral compared to clinician referral alone. Given the similarities between HIV and OUD, we will adapt the evidence-based Anti-Retroviral Treatment and Access to Services (ARTAS) protocol to enhance linkage of individuals with OUD to opioid agonist treatment. We will conduct a qualitative study that includes key informant interviews with persons who misuse opioids, treatment and clinical providers, and patient navigators to inform the essential modifications to ARTAS that would be necessary to enhance linkage to initiation and retention in treatment for OUD. Information from the interviews will be augmented with prior literature and other evidence-based models to finalize the pilot intervention. We will pilot the developed intervention in individuals with moderate to severe opioid use disorder who are not currently in treatment. We will recruit 108 participants from the Denver Health ED to compare the intervention (n=58) to standard of care (n=58) using a block randomization design. Our primary outcome will be treatment initiation within 30 days of randomization and secondary outcomes will include treatment engagement at one and three months, number of opioid use days, non-fatal overdose, and fatal overdose.