Peer Engagement in Methamphetamine Harm-Reduction with Contingency Management (PEER-CM)

同伴参与通过应急管理减少甲基苯丙胺危害 (PEER-CM)

• 批准号: 10590236
• 负责人: Philip Todd Korthuis
• 金额: $ 193.64万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590236
• 关键词: Achievement; Age; Behavior; COVID-19 pandemic; Caring; Client; Collaborations; Communities; Contingency Fund; County; Drug usage; Effectiveness; Evidence based intervention; Fentanyl; Funding; Goals; Harm Reduction; Health; Hybrids; Incentives; Intervention; Interview; Knowledge; Life; Methamphetamine; Methamphetamine overdose; Modeling; Naloxone; Oregon; Overdose; Overdose reduction; Participant; Persons; Pharmaceutical Preparations; Policies; Process; Randomized; Recovery Support; Reporting; Rewards; Risk; Rural; Sampling; Services; Site; Social support; Specialist; Structure; Substance Use Disorder; Syringes; Testing; Time; Training; United States; Visit; Work; authority; base; contingency management; design; evidence base; implementation facilitators; implementation framework; implementation strategy; improved; innovation; meetings; methamphetamine use; opioid use; outreach program; overdose death; patient oriented; peer; peer networks; prevent; programs; psychostimulant; rural setting; scale up; standard of care; stem; stimulant use; test strip; treatment comparison; treatment services; trend; urban setting

Project Summary/Abstract Use of fentanyl and methamphetamine (MA) made 2021 the deadliest year ever for people using drugs in the United States (US). Intentional co-use as well as rising adulteration of MA with fentanyl elevate the risks and harms associated with MA use – the age-adjusted rate of drug overdose deaths involving psychostimulants (primarily MA) increased 10-fold between 2009 and 2019. Little is known about preventing overdoses involving MA or engaging people using MA in harm reduction and treatment. Strategies to engage people who use MA in harm reduction activities are essential. Contingency management (CM) uses rewards to incentivize behaviors and is the most efficacious strategy for improved retention in treatment and reduced stimulant use. Peer recovery support specialists reach people not seeking treatment to help them identify harm reduction goals and engage in treatment. The PEER-CM study combines both evidence-based interventions—CM and peer engagement--to decrease overdose and improve engagement in harm reduction services for people who use MA. Our network of peer harm reduction organizations is eager to identify optimal strategies for implementing Oregon’s recent approval of sustainable CM funding to reduce overdose. The PEER-CM study tests the effect of incentivizing achievement of self-identified, personal harm reduction goals compared with standard of care (peer harm reduction service with incentives for peer visits) to increase the reach and effectiveness of MA harm reduction services. A hybrid type 1 effectiveness-implementation framework and stepped-wedge design randomizes eighteen community-based peer harm reduction sites to provide standard of care (incentives for peer encounters) versus client achievement of self-identified, personal harm reduction goals. Peers assist clients in setting personal harm reduction goals using a client-driven harm reduction goal- setting process focused on completing harm reduction supply training, possessing harm reduction supplies, daily life goals, treatment and care goals, and relationship and social support goals. The CM intervention is rolled out at three-month intervals in the stepped-wedge design (2 peer sites at a time). Peers manage incentives and facilitate progress towards meeting self-identified goals. Aim 1 tests the impact of incentives for achieving self-identified, personal harm reduction goals on the likelihood of overdose among people using MA. Aim 2 determines whether incentives for achieving self-identified, personal harm reduction goals increase engagement with harm reduction and treatment services. Aim 3 completes qualitative interviews to understand the optimal context and implementation strategies for peer-facilitated contingency management. The PEER- CM study advances a patient-centered, sustainable, scalable, and innovative contingency management model to increase the impact of harm reduction delivered outside of traditional treatment networks and stem the tide of overdose among people who use MA. The collaboration with the Oregon Health Authority’s peer initiative facilitates policy change and sustainable services well beyond the proposed work.

项目总结/摘要 芬太尼和甲基苯丙胺（MA）的使用使2021年成为美国吸毒者有史以来最致命的一年。 United States（US）.有意的共同使用以及越来越多的MA与芬太尼的掺假增加了风险， 与MA使用相关的危害-涉及精神兴奋剂的药物过量死亡的年龄调整率 （主要是MA）在2009年至2019年期间增加了10倍。关于预防过量用药知之甚少， MA或让使用MA的人参与减少伤害和治疗。吸引使用MA的人的策略 在减少危害活动中至关重要。应急管理（CM）使用奖励来激励 行为，是改善治疗保留和减少兴奋剂使用的最有效策略。 同伴康复支持专家接触不寻求治疗的人，帮助他们确定减少伤害 目标并参与治疗。PEER-CM研究结合了循证干预-CM和 同伴参与--减少吸毒过量并改善人们对减少伤害服务的参与 使用MA。我们的减少同伴伤害组织网络渴望确定最佳策略， 实施俄勒冈州最近批准的可持续CM资金，以减少过量。PEER-CM研究 测试激励实现自我确定的个人伤害减少目标的效果， 护理标准（减少同伴伤害服务，鼓励同伴探视），以扩大覆盖面， 降低MA危害服务的有效性。混合型第1类有效性-执行框架， 阶梯楔形设计随机抽取了18个社区为基础的减少同伴伤害网站， 护理（同伴接触的激励措施）与客户实现自我识别，个人伤害减少 目标.同行协助客户使用客户驱动的伤害减少目标来设定个人伤害减少目标- 设定过程的重点是完成减少危害用品培训，拥有减少危害用品， 日常生活目标，治疗和护理目标，以及关系和社会支持目标。CM干预是 在阶梯楔形设计中每隔三个月推出一次（每次2个对等站点）。同行管理 鼓励和促进实现自我确定的目标。目标1测试激励措施的影响， 在使用MA的人群中实现自我确定的减少个人伤害的目标。 目标2决定了实现自我确定的个人伤害减少目标的激励是否增加 参与减少伤害和治疗服务。目标3完成定性访谈，以了解 同行促进的应急管理的最佳背景和实施战略。同行- CM研究推进了以患者为中心的，可持续的，可扩展的和创新的应急管理模式 在传统治疗网络之外增加减少危害的影响， 使用MA的人中过量使用。与俄勒冈州卫生局的同行倡议合作 促进政策变化和可持续服务远远超出拟议的工作。