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阿片类药物使用障碍的有效药物有限 （MOUD）减少过量。传统上，美国的监狱和监狱不会启动或维护MOUD， 在返回社区之前患有OUD的囚犯，这使他们面临致命过量的高风险。一 2018年的法律（“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 FDA批准的MOUD（缓释纳洛酮[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，以扩大所有FDA批准的MOUD形式， 五个县监狱;马州另外两个县监狱自愿加入了这一倡议。法律规定，MOUD 在拘留前对接受该方案的个人进行维持，在被判刑的囚犯中在释放前启动 在适当的时候。七所监狱还必须便利社区继续提供药物， release.马萨诸塞州司法社区阿片类药物创新网络提议与这些公司合作， 七个不同的监狱和社区治疗提供者进行类型1混合有效性- 第208章执行研究我们将：（1）进行纵向治疗结果研究， 患有OUD的囚犯谁收到XR-NTX，BUP-NX，美沙酮，或没有MOUD在监狱利用MA的强大和 创新的公共卫生数据仓库，收集了二十多个相互关联的国家行政数据集， 检查释放后MOUD的启动，参与和保留，以及致命和非致命过量 和累犯倾向评分方法将根据选择效应进行调整。(2)进行实施研究 了解在监狱和社区护理中促进和阻碍MOUD交付的背景因素 协调和最佳实践战略，优化监狱中的MOUD交付，并与 社区合作伙伴。(3)进行拮抗剂（XR-NTX）的初步随机比较有效性试验 与激动剂治疗（BUP-NX或美沙酮）相比，在100名被判刑者中， 他们在释放后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、可行性和效应量，以支持未来随机化 效果比较试验。(4)计算在监狱中实施MOUD的惩教系统的成本， 从国家决策者和社会的角度进行经济评价， 从监狱释放前的MOUD到匹配对照中的无MOUD。 Mass JCOIN团队与MA公共卫生部合作， 和社区治疗合作伙伴，有经验和专业知识，以实现研究目标。第208章 该倡议对司法和OUD治疗系统的未来政策和实践具有重要影响， 地方、州和国家层面。本研究对第208章执行情况的见解将告知 有效制定未来战略，以解决全国监狱人口中的吸毒过量问题。

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.