Impact of PTSD and trauma reexposure on buprenorphine maintenance treatment in syringe exchange programs

注射器交换项目中 PTSD 和创伤再暴露对丁丙诺啡维持治疗的影响

• 批准号: 10115954
• 负责人: Aaron D Fox
• 金额: $ 10.37万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10115954
• 关键词: Abstinence; Affect; Buprenorphine; Caring; Client; Clinical; Clinical Investigator; Data; Development; Development Plans; Diagnosis; Drug Screening; Enrollment; Focus Groups; Foxes; Grant; HIV; HIV risk; Health Services; Injecting drug user; Injections; Intervention; Interview; Knowledge; Maintenance; Medical; Methods; Needle-Exchange Programs; Neighborhood Health Center; Opioid; Participant; Patient Self-Report; Pharmaceutical Preparations; Population; Post-Traumatic Stress Disorders; Prevention; Provider; Psychologist; Randomized; Randomized Controlled Trials; Research; Research Personnel; Risk; Risk Behaviors; Severities; Sterility; Structure; Symptoms; Syringes; Testing; Time; Trauma; Treatment Efficacy; United States; Urine; Visit; base; buprenorphine treatment; career development; community clinic; design; drug use behavior; experience; illicit opioid; novel; opioid use; opioid use disorder; opioid user; overdose death; prospective; recruit; stress related disorder; symptomatology; traumatic event; treatment risk; treatment strategy; urban area

In the United States, opioid use disorder (OUD) and overdose deaths are increasing; yet 80% of people with OUD remain out of treatment. Operating in 33 states, syringe exchange programs (SEPs), which provide sterile syringes and other health services to people who inject drugs, are a key venue to reach out-of-treatment opioid users. In a 24-week randomized controlled trial based in a large urban area with high rates of OUD and HIV, Project BLOOM (R01DA044878, [PI: Fox]) will recruit 250 out-of-treatment opioid users who utilize SEPs and randomize 1:1 to onsite buprenorphine treatment (O-BMT) or enhanced referral. Over two weeks, participants in the O-BMT condition will see a buprenorphine provider twice onsite, receive weekly medication packs, and then their care will be transferred to a community health center for maintenance buprenorphine treatment. The proposed diversity supplement will support Dr. Teresa López-Castro, a clinical psychologist and early-stage investigator, to study barriers to engagement in buprenorphine treatment that are related to Post- Traumatic Stress Disorder (PTSD) and traumatic event re-exposure. Project BLOOM has identified structural barriers to OUD treatment and is testing SEP-based buprenorphine initiation as a way to minimize delays in starting buprenorphine treatment. However, PTSD and the experiencing of new traumatic events (traumatic event re-exposure) are exceedingly common among people with OUD, affect drug use behaviors, and will likely modify O-BMT’s effects. Thus designing novel engagement and treatment strategies requires consideration of PTSD and traumatic event re-exposure. The objectives of the proposed mixed methods study are two-fold: (1) to quantitatively evaluate the moderating effect of PTSD and traumatic event re-exposure on the efficacy of O-BMT; and (2) to collect qualitative data from stakeholders (SEP consumers and staff) on the PTSD-related treatment needs for IDUs. The proposed two-year diversity supplement will create generalizable knowledge regarding how PTSD and traumatic event re- exposure impact buprenorphine treatment efficacy. The application also proposes a comprehensive career development plan that will also support Dr. López-Castro’s further development as a clinical investigator.

在美国，阿片类药物使用障碍(OUD)和过量死亡正在增加；然而 80%的OUD患者仍然得不到治疗。在33个州开展业务，更换注射器 计划(SEP)，为注射的人提供无菌注射器和其他健康服务 毒品，是接触非治疗阿片类药物使用者的关键场所。在一项为期24周的随机调查中 布卢姆项目，在艾滋病和艾滋病毒感染率较高的大城市地区进行对照试验 (R01DA044878，[PI：FOX])将招募250名使用SEPS和 随机1：1到现场丁丙诺啡治疗(O-BMT)或加强转诊。超过两个人 几周后，O-BMT条件下的参与者将在现场看到丁丙诺啡提供者两次， 每周接受一包药物，然后他们的护理将被转移到社区卫生部门 丁丙诺啡维持治疗中心。拟议的多样性补充方案将 支持临床心理学家、早期研究人员特蕾莎·L·卡斯特罗博士 研究参与丁丙诺啡治疗的障碍与后 创伤应激障碍(PTSD)和创伤事件再暴露。布卢姆项目已经 确定了OUD治疗的结构性障碍，并正在测试基于SEP的丁丙诺啡启动 作为一种最大限度减少丁丙诺啡治疗延迟的方法。然而，创伤后应激障碍和 经历新的创伤事件(创伤事件再次暴露)是非常常见的 在患有OUD的人中，会影响药物使用行为，并可能会改变O-BMT的效果。 因此，设计新的参与和治疗策略需要考虑创伤后应激障碍和 创伤性事件再次曝光。拟议的混合方法研究的目标有两个： (1)定量评价创伤后应激障碍和创伤事件再暴露对创伤的调节作用。 O-BMT的有效性；以及(2)从利益相关者(SEP消费者)那里收集定性数据 和工作人员)关于注射吸毒者与创伤后应激障碍相关的治疗需求。拟议的两年多样性 补充内容将创建关于创伤后应激障碍和创伤事件如何恢复的一般性知识 暴露影响丁丙诺啡治疗效果。应用程序还提出了一个 全面的职业发展计划，也将支持L-卡斯特罗博士进一步 发展成为一名临床研究人员。