Long-Term Treatment of Opioid Use Disorder

贫困和阿片成瘾是相互关联的长期问题，尚未得到解决 足够了。治疗工作场所可以治疗许多患有阿片类药物使用障碍的成年人 失业，生活贫困。治疗工作场所向参与者支付工作费用。宣传毒品 禁欲，治疗工作场所安排以就业为基础的禁欲强化，其中 参赛者被要求提供不含毒品的尿样，以维持最高工资。许多研究都有 表明在治疗工作场所以就业为基础的戒烟强化可以促进和 坚持戒毒。最近，我们证明了节欲相关的工资补充在 治疗工作场所可以促进戒毒和就业，减少贫困。然而，我们 还没有证明治疗工作场所的现实影响。治疗工作场所 需要两次修改才能产生现实世界的影响。1)我们必须开发一个真实版本的 社区治疗计划可以实施的治疗工作场所。2)我们必须降低成本 保持以就业为基础的禁欲强化。此应用程序旨在开发和评估 低成本的治疗工作场所，社区治疗方案可以实施，并解决 阿片成瘾和贫穷的顽固性。我们建议进行一项第三阶段研究，在该阶段内 社区诊所(REACH Health Services)采用并实施治疗工作场所干预。至 提高这种干预的可行性，我们将使用低成本的或有禁欲的工资补充 保持节制。我们建议进行一项随机对照研究，以评估 低成本戒酒-社区治疗工作场所的临时工资补充，以维持长期- 长期戒毒和就业，并减少阿片类药物使用障碍成年人的贫困。在4周后 诱导期，到达无业的美沙酮或丁丙诺啡阿片类药物使用障碍患者(N=225) 将被随机分配到“日常护理控制”、“仅限入门”或“入门和维护” 一群人。所有小组将继续接受美沙酮或丁丙诺啡治疗，并将接受 就业专家72周。“印心”和“印心及维持”参与者将获得 高幅度戒酒-24周入门期间(每小时8美元)的临时工资补充 1-24)。“启蒙和维持”参与者还将获得少量禁欲--临时工资 补充剂(1美元/小时)，在48周的维护期内(25-72周)。我们将以初选为基地 在维持期内每四周进行一次评估的结果衡量标准。如果成本低 戒毒--社区治疗工作场所的工资补贴维持戒毒 和就业，减少贫困，社区药物滥用治疗诊所可以应用这种干预措施 广泛作为阿片类药物使用障碍的失业成年人的长期维持治疗。

Poverty and opioid addiction are interrelated and chronic problems which have not been addressed adequately. The Therapeutic Workplace could treat the many adults with opioid use disorder who are unemployed and live in poverty. The Therapeutic Workplace pays participants to work. To promote drug abstinence, the Therapeutic Workplace arranges employment-based abstinence reinforcement in which participants are required to provide drug-free urine samples to maintain maximum wages. Many studies have shown that employment-based abstinence reinforcement in the Therapeutic Workplace can promote and maintain drug abstinence. Recently, we showed that abstinence-contingent wage supplements in the Therapeutic Workplace could promote drug abstinence and employment, and reduce poverty. However, we have not demonstrated the real-world impacts of the Therapeutic Workplace. The Therapeutic Workplace requires two modifications to produce real world impacts. 1) We must develop a real-world version of the Therapeutic Workplace that community treatment programs can implement. 2) We must reduce the costs of maintaining employment-based abstinence reinforcement. This application seeks to develop and evaluate a low-cost Therapeutic Workplace that community treatment programs can implement and that addresses the persistent nature of opioid addiction and poverty. We propose to conduct a Stage III study in which a community clinic (REACH Health Services) adapts and implements the Therapeutic Workplace intervention. To improve the feasibility of this intervention, we will use low-cost abstinence-contingent wage supplements to maintain abstinence. We propose to conduct a randomized controlled study to evaluate the effectiveness of the low-cost abstinence-contingent wage supplements in a community Therapeutic Workplace to maintain long- term drug abstinence and employment, and to reduce poverty in adults with opioid use disorder. After a 4-week induction period, REACH unemployed methadone or buprenorphine patients with opioid use disorder (N=225) will be randomly assigned to a “Usual Care Control,” an “Initiation Only,” or an “Initiation and Maintenance” group. All groups will continue to receive methadone or buprenorphine treatment and will receive an employment specialist for 72 weeks. “Initiation Only” and “Initiation and Maintenance” participants will earn high magnitude abstinence-contingent wage supplements ($8/hour) during a 24-week Initiation period (weeks 1-24). “Initiation and Maintenance” participants will also earn low-magnitude abstinence-contingent wage supplements ($1/hour) during a 48-week Maintenance period (weeks 25-72). We will base the primary outcome measures on assessments conducted every four weeks of the Maintenance period. If low-cost abstinence-contingent wage supplements in the community Therapeutic Workplace maintain drug abstinence and employment and decrease poverty, community drug abuse treatment clinics could apply this intervention widely as a long-term maintenance treatment for unemployed adults with opioid use disorder.