Project POINT: Effectiveness and Scalability of an Overdose Survivor Intervention

阿片类药物滥用和成瘾在美国处于历史高位，阿片类药物过量造成的死亡 在过去的16年里翻了两番。尽管存在重大需求，但仍存在大量的治疗和设计障碍 防止许多阿片类药物使用者获得药物辅助治疗(MAT)，这是黄金标准治疗 用于阿片类药物使用障碍(OUD)。计划的外展、干预、纳洛酮和治疗(POINT)是 以急诊科(ED)为基础的外联计划，将阿片类药物过量幸存者纳入垫子。 Point建立在以前基于ED的阿片使用障碍(OUD)的优点和缺点的基础上 干预措施。Point本质上是一个关键的时间干预，因为它寻求快速动员支持 处于生命的关键时刻的高度脆弱人群的成员，此时他们可能会接受 协助(即服药过量后)。它通过使用恢复教练(即，具有 接受过培训以帮助那些与毒瘾作斗争的人的康复生活经历)帮助患者 在电火花放电后穿过栅栏进入垫子。康复教练在药物滥用中的应用 服务的前提是患者将更愿意与患者分享他们的个人挣扎 有过类似经历的人。该项目的主要目标是建立Points AS 一种有效和可扩展的干预措施，可让患者参与MAT。这项研究采用了混合类型1 有效的实施设计，以充分利用当前的点数扩张努力 发生在印第安纳州。该项目的目标1是在一家新医院复制POINT，这将为 通过(A)评估选定的实施战略，为随后的可行性测试进行干预 以及(B)试行研究方案和二次数据收集程序，为我们向 我们研究的下一阶段。目标2是进行一项多点、实用的随机整群试验，以(A)建立 与标准护理相比，POINT的有效性和(B)加强我们对POINT对 通过对部分点状患者进行纵向访谈，了解康复过程。目标3将 通过(A)成本效益分析，确定POINT对其他医院和系统的潜在可扩展性 (B)与潜在的POINT采用者进行有组织的访谈，他们可以帮助我们确定潜在的障碍和 推动者为未来的扩展活动提供信息。该项目与印第安纳州的21世纪疗法密切相关 ACT资助，因为该州治疗法案申请的目标4寻求发展印第安纳州恢复和同行 支持倡议(IRPSI)，将在全州的各种医院实施基于ED的同行支持。 事实上，IRPSI是基于POINT的初步工作。印第安纳州心理健康和成瘾部， 管理印第安纳州治疗法案资金的公司，已经与我们合作，利用他们的活动来实施 IRPSI作为一种拓展和研究的手段。因此，我们有一个独特的机会来研究一个 处于萌芽阶段的干预措施。上述目标的成功实现将使我们保持镇定 在更大的研究和/或比较中进一步测试点的有效性和实施结果 类似干预措施的有效性(例如，在急诊室提供丁丙诺啡处方)。

Opioid misuse and addiction are at historic heights in the United States, and deaths due to opioid overdose have quadrupled over the past 16 years. Despite significant need, substantial treatment and design barriers prevent many opioid users from accessing medication assisted treatment (MAT), the gold standard treatment for opioid use disorder (OUD). Planned Outreach, Intervention, Naloxone, and Treatment (POINT) is an emergency department (ED)-based outreach program for engaging opioid overdose survivors into MAT. POINT builds on the strengths and addresses weaknesses of previous ED-based opioid use disorder (OUD) interventions. POINT is essentially a critical time intervention in that it seeks to quickly mobilize support for members of a highly vulnerable population at a juncture in their lives when they are likely to be receptive to assistance (i.e., after an overdose). It accomplishes this through use of recovery coaches (i.e., individuals with lived experience of recovery who are trained to assist those struggling with addiction) who assist patients to navigate barriers to MAT access after ED discharge. The use of recovery coaches in substance abuse services is based in the premise that patients will be more receptive to sharing their personal struggles with someone who has had similar experiences. The primary goal of this project is the establishment of POINT as an effective and scalable intervention for engaging patients in MAT. This study employs a Hybrid Type 1 effectiveness implementation design to take full advantage of current POINT expansion efforts currently happening in Indiana. Aim 1 of this project is to replicate POINT in a new hospital, which will prepare the intervention for subsequent feasibility testing through (a) assessment of the chosen implementation strategy and (b) the piloting of research protocols and secondary data collection procedures to inform our transition to the next stage of our study. Aim 2 is to conduct a multi-site, pragmatic randomized cluster trial to (a) establish POINT’s effectiveness compared to standard care and (b) enhance our understanding of POINT’s effect on the recovery process through longitudinal interviews conducted with a subset of POINT patients. Aim 3 will determine POINT’s potential scalability to other hospitals and systems through (a) a cost benefit analysis and (b) structured interviews with potential adopters of POINT who can assist us in identifying potential barriers and facilitators to inform future scaling activities. This project is strongly aligned with Indiana’s 21st Century Cures Act funding, as Goal 4 of the state’s Cures Act application seeks to develop the Indiana Recovery and Peer Support Initiative (IRPSI), which will implement ED-based peer supports in various hospitals across the state. Indeed, the IRPSI is based on POINT’s preliminary work. Indiana’s Division of Mental Health and Addiction, which manages the Indiana’s Cures Act funding, has partnered with us to leverage their activities to implement the IRPSI as a means of expanding and studying POINT. Therefore, we have a unique opportunity to study an intervention that is being scaled in its nascent phases. Successful completion of the above aims will poise us to further test POINT’s effectiveness and implementation outcomes in a larger study and/or compare effectiveness with similar interventions (e.g., provision of buprenorphine prescriptions in the ED setting).