Kentucky Women's Justice Community Opioid Innovation Network (WJCOIN)

摘要 阿片类药物危机继续肆虐美国社区，过量死亡人数达到历史最高水平。妇女 由于疼痛敏感性增加，医生处方实践， 和自我药疗，以及从阿片类药物暴露到阿片类药物使用障碍发展的更快轨迹 （OUD）。自1999年以来，女性阿片类药物过量死亡率上升了492%，高于男性 (404%).然而，关于增加阿片类药物使用障碍的救生药物启动的方法的研究 妇女的参与程度有限。肯塔基州大学提议建立妇女临床 研究中心是NIDA司法社区阿片类药物创新网络（W-JCOIN）的一部分。整体 W-JCOIN的目标是在涉及司法的高风险妇女中增加MOUD的启动和维护 从监狱到社区的过渡，以减少阿片类药物复吸和过量。作为NIH合作项目的一部分， 网络，W-JCOIN将领导1型混合有效性和实施试验，以检查一个创新的 使用远程医疗（单独和与同行导航器相结合）的MOUD治疗前模型，用于涉及正义的 从监狱过渡到社区的妇女，6项实验和3项比较（作为监狱服务-SAU） 网站.本研究的目的是：（1）比较MOUD预治疗远程医疗的效果 （单独与与同伴导航器组合），以增加高- 风险，正义参与释放后的妇女在社区相对于服务照常（SAU）。(2)估计 MOUD治疗前远程保健的增量成本和成本效益（单独使用和与同行 导航员）相对于SAU的高风险司法涉及OUD妇女在实现预期的变化， 临床，公共卫生和公共安全结果超过一年后发布。(3)检查时间变化， EPIS框架假设的影响成功创新的关键实施结构 实施.该应用程序由NIH资助的研究人员组成的经验丰富的团队提供支持， 参与NIH司法研究合作的记录。研究小组处于有利地位，可以成为积极的成员 JCOIN网络，以迅速开展对OUD的优质护理研究，特别关注服务不足和 被忽视的正义女性KY W-JCOIN有可能对OUD产生重大影响 通过提供关于创新的有效性和实施的经验证据， 技术，以增加启动和维持救生药物在一个关键的，高风险的时间 在城市和非城市社区，弱势、参与司法的妇女重返社区。的 这项研究的长期目标是提高司法系统应对阿片类药物危机的能力 通过增加获得治疗的机会，减少阿片类药物复吸和过量。

ABSTRACT The opioid crisis continues to ravage US communities with overdose deaths at an all-time high. Women are disproportionately affected by the opioid crisis due to increased pain sensitivity, physician prescribing practices, and self-medication, as well as a faster trajectory from opioid exposure to the development of opioid use disorder (OUD). The opioid overdose death rate among women has risen 492% since 1999, a higher rate than men (404%). However, research on approaches to increase initiation of life-saving medications for opioid use disorder (MOUD) among women is limited. The University of Kentucky proposes to establish the Women’s Clinical Research Center as part of the NIDA Justice Community Opioid Innovation Network (W-JCOIN). The overall goal of the W-JCOIN is to increase initiation and maintenance of MOUD among high-risk justice-involved women in the transition from jail to the community to reduce opioid relapse and overdose. As part of this NIH collaborative network, the W-JCOIN will lead a type 1 hybrid effectiveness and implementation trial to examine an innovative MOUD pre-treatment model using telehealth (alone and in combination with peer navigators) for justice-involved women in transition from jail to the community in 6 experimental and 3 comparison (Services as Usual-SAU) sites. The following aims guide the study: (1) Compare the effectiveness of MOUD Pre-Treatment Telehealth (alone versus in combination with Peer Navigators) to increase MOUD initiation and maintenance among high- risk, justice-involved women in the community after release relative to services as usual (SAU). (2) Estimate the incremental cost and cost effectiveness of MOUD Pre-Treatment Telehealth (alone and in combination with Peer Navigators) relative to SAU for high-risk justice involved women with OUD in achieving desired changes in clinical, public health, and public safety outcomes over one-year post-release. (3) Examine temporal changes in key implementation constructs hypothesized by the EPIS framework to influence successful innovation implementation. This application is supported by an experienced team of NIH funded investigators with a track record of engaging in NIH justice research cooperative. The research team is well-positioned to be active members of the JCOIN network to rapidly conduct studies on quality care for OUD, with special focus on underserved and understudied justice-involved women. The KY W-JCOIN has the potential for significant impact on the OUD treatment field by contributing empirical evidence on the effectiveness and implementation of innovative technologies to increase initiation and maintenance of life-saving medications during a critical, high-risk time of community re-entry among vulnerable, justice-involved women in both urban and non-urban communities. The long-term goal of this research is to increase the capacity for the justice system to respond to the opioid crisis through increased access to treatment to reduce opioid relapse and overdose.