Massachusetts Justice Community Opioid Innovation Network (JCOIN) Clinical Research Center

美国阿片类药物危机的一个主要驱动因素是获得有效治疗阿片类药物使用障碍药物的机会有限 （MOUD）减少过量。传统上，美国的看守所和监狱不会发起或维持 MOUD 囚犯在返回社区之前就患有 OUD，这使他们面临服药过量致死的高风险。一个 2018 年法律（“第 208 章”）使马萨诸塞州 (MA) 成为第一个强制五个县监狱交付所有囚犯的州。 FDA 批准的 MOUD（缓释纳曲酮 [XR-NTX] 丁丙诺啡纳洛酮 [BUP-NX]，以及 美沙酮）。第 208 章建立了一个为期 4 年的试点计划，以扩大 FDA 批准的所有 MOUD 形式 五个县监狱；马萨诸塞州另外两个县监狱自愿加入了这一倡议。法律规定 MOUD 是 保存在拘留前接收的个人中，并在被判刑的囚犯释放之前启动 在适当的情况下。七所监狱还必须促进社区继续接受药物治疗 释放。马萨诸塞州司法社区阿片类药物创新网络提议与这些机构合作 七个不同的监狱和社区治疗提供者进行 1 类混合有效性- 第 208 章的实施研究。我们将： (1) 对患者进行纵向治疗结果研究 使用 MA 的强大和 创新的公共卫生数据仓库，收集了两打以上相互关联的国家行政数据集， 检查发布后 MOUD 的启动、参与和保留，以及致命和非致命的用药过量 和累犯。倾向评分方法将根据选择效果进行调整。 （二）开展实施研究 了解促进和阻碍在监狱和社区护理中实施 MOUD 的背景因素 协调和最佳实践策略，优化 MOUD 在监狱中的交付并协调护理 社区合作伙伴。 (3) 进行拮抗剂（XR-NTX）的试点随机比较有效性试验 对比 100 名被判刑者和后续释放者在释放前开始的激动剂治疗（BUP-NX 或美沙酮） 他们在发布后 12 个月检查无法在行政数据中评估的结果， 确定程序、可接受性、可行性和效果大小，以支持未来随机试验的规划 比较有效性试验。 (4) 计算监狱中实施MOUD对惩教系统的成本， 并从国家政策制定者和社会角度进行经济评估，比较其价值 出狱前的 MOUD 到匹配对照中无 MOUD。 Mass JCOIN 团队与马萨诸塞州公共卫生部、马萨诸塞州七个县监狱合作 和社区治疗合作伙伴，拥有实现研究目标的经验和专业知识。第208章 倡议对司法和 OUD 处理系统的未来政策和实践具有重要影响 地方、州和国家各级。本研究对第 208 章实施的见解将为 有效制定未来战略，以解决全国监狱人口中的 OUD 问题。

A major driver of the U.S opioid crisis is limited access to effective medications for opioid use disorder (MOUD) that reduce overdose. Traditionally, jails and prisons in the U.S. do not initiate or maintain MOUD for inmates with OUD prior to their return to the community, which places them at high risk for fatal overdose. A 2018 law (“Chapter 208”) made Massachusetts (MA) the first state to mandate that five county jails deliver all FDA-approved MOUDs (extended-release naltrexone [XR-NTX] buprenorphine-naloxone [BUP-NX], and methadone). Chapter 208 establishes a 4-year pilot program to expand all FDA-approved forms of MOUD at five county jails; two more county jails in MA voluntarily joined this initiative. The law stipulates that MOUD be maintained in individuals receiving it prior to detention, and initiated prior to release among sentenced inmates where appropriate. The seven jails must also facilitate continuation of the medication in the community on release. The Massachusetts Justice Community Opioid Innovation Network proposes to partner with these seven diverse jails and community treatment providers to conduct a Type 1 hybrid effectiveness- implementation study of Chapter 208. We will: (1) Perform a longitudinal treatment outcome study among inmates with OUD who receive XR-NTX, BUP-NX, methadone, or no MOUD in jail utilizing MA’s powerful and innovative Public Health Data Warehouse, a collection of over two dozen linked state administrative data sets, to examine post-release MOUD initiation, engagement and retention, as well as fatal and non-fatal overdose and recidivism. Propensity score methods will adjust for selection effects. (2) Conduct an implementation study to understand contextual factors that facilitate and impede delivery of MOUDs in jail and community care coordination, and best practice strategies that optimize MOUD delivery in jail and coordinated care with community partners. (3) Perform a pilot randomized comparative effectiveness trial of antagonist (XR-NTX) versus agonist treatment (BUP-NX or methadone) initiated prior to release among 100 sentenced and follow- them 12-months post-release to examine outcomes that cannot be assessed in administrative data and determine procedures, acceptability, feasibility and effect sizes to support planning for a future randomized comparative effectiveness trial. (4) Calculate the cost to the correctional system of implementing MOUD in jail, and conduct an economic evaluation from state-policymaker and societal perspectives to compare the value of MOUD prior to release from jail to no MOUD among matched controls. The Mass JCOIN team, in collaboration with the MA Department of Public Health, seven MA county jails and community treatment partners, has the experience and expertise to fulfill the study aims. The Chapter 208 initiative has important implications for future policy and practice in the justice and OUD treatment systems at the local, state, and national levels. This study’s insights into Chapter 208’s implementation will inform the efficient development of future strategies to address OUDs in jail populations nationwide.