A Bridge to Treatment for Out-of-Treatment Injection Heroin Users

说明（由申请人提供）：注射吸毒是艾滋病毒的常见传播方式。美沙酮可以减少注射海洛因的使用和与注射有关的艾滋病毒危险行为，但大多数注射海洛因使用者难以参与治疗。计划进行一项为期5年的随机研究，以评估治疗场所在促进失业者、未接受治疗者、注射海洛因使用者参与美沙酮治疗和增加戒毒方面的有效性。治疗性工作场所是一种新颖的基于就业的干预措施，使用工作工资来加强临床上重要的行为改变。工作场所参与者在支持的工作场所工作是有报酬的。为了促进临床上重要的行为，工资是根据工作和这些行为来安排的。在本研究中，参与者将被邀请到工作场所并参加美沙酮治疗。在工作入职期间，参与者将被允许独立于他们是否参加美沙酮治疗和他们的药物使用而工作和赚取工资。4周后，工作场所参与者（N = 162）将被随机分配到三组之一。所有小组将被邀请到工作场所参加为期26周的活动。“美沙酮应急计划”的参与者将被要求在上班时服用美沙酮，并将因少服一剂而获得短暂的减薪。由于许多海洛因使用者甚至在美沙酮治疗期间也吸食可卡因，“美沙酮与戒断意外事件”的参与者将被要求服用美沙酮去上班，并因错过美沙酮剂量或提供可卡因阳性尿样而获得短暂的减薪。“常规护理”参与者将被允许独立于他们的美沙酮使用或尿液分析结果。我们预计“美沙酮应急”组将增加美沙酮的依从性并减少海洛因的使用；“美沙酮和戒断应急”小组将增加美沙酮的依从性，减少海洛因和可卡因的使用。由于美沙酮在患者入组后有效地保留治疗，我们期望一旦“美沙酮偶然性”使参与者参与美沙酮治疗，美沙酮将在治疗场所暴露结束后维持他们对治疗的参与。治疗场所可以作为一个桥梁，使未接受治疗的注射海洛因使用者参与美沙酮治疗，并减少他们的吸毒和与注射有关的艾滋病毒风险行为。

DESCRIPTION (provided by applicant): Injection drug use is a common mode of HIV transmission. Methadone can reduce injection heroin use and injection-related HIV risk behaviors, but most injection heroin users are difficult to engage in treatment. A randomized study is planned over 5 years to evaluate the effectiveness of the Therapeutic Workplace in promoting engagement in methadone treatment and increasing drug abstinence in unemployed, out-of- treatment, injection heroin users. The Therapeutic Workplace is a novel employment-based intervention that uses wages for work to reinforce clinically important behavior change. Workplace participants are paid to work in a supported workplace. To promote clinically important behaviors, wages are arranged contingent both on work and those behaviors. In this study, participants will be invited to attend the workplace and enroll in methadone treatment. During a workplace induction period, participants will be allowed to work and earn wages independent of whether they enroll in methadone treatment and independent of their drug use. After 4 weeks, workplace participants (N = 162) will be randomly assigned to one of three groups. All groups will be invited to attend the workplace for 26 weeks. "Methadone Contingency" participants will be required to take methadone to work, and will receive a brief pay decrease for missing a dose. Because many heroin users also use cocaine, even during methadone treatment, "Methadone and Abstinence Contingency" participants will be required to take methadone to work, and will receive a brief pay decrease for missing a methadone dose or for providing a cocaine-positive urine sample. "Usual Care" participants will be allowed to work independent of their methadone use or urinalysis results. We expect that the "Methadone Contingency" group will increase methadone adherence and decrease heroin use; and that the "Methadone and Abstinence Contingency" group will increase methadone adherence, and decrease heroin and cocaine use. Since methadone is effective at retaining patients in treatment once enrolled, we expect that once the "Methadone Contingency" engages participants in methadone treatment, the methadone will serve to maintain their participation in treatment after exposure to the Therapeutic Workplace ends. The Therapeutic Workplace could serve as a bridge to engage out-of-treatment injection heroin users into methadone treatment, and to reduce their drug use and injection-related HIV risk behaviors.