DAT18-08 Geographic variation in Opioid Addiction Treatment (GATE) study: Multi-Level Factors Influencing MAT Use, Other Treatment, & Adverse Outcomes among Re-entering Rural and Urban Prisoners

摘要：如DAT 18 -08所述，NIDA对了解治疗利用率有着浓厚的兴趣， 阿片类药物使用障碍（POUD）的人，因为他们从监狱过渡到社区， 阿片类药物使用障碍（OUD）患者同时改善了公共健康和公共安全。肯塔基州 目前正处于阿片类药物危机之中，每年都有许多POUD在刑事司法系统中循环。而 成瘾治疗的循证药物（MAT）用于治疗OUD，MAT在 监狱，这提高了复发和过量的风险时，POUD被释放，并重新进入他们的 社区.研究很少涉及与犯罪者主动犯罪意愿相关的多层次因素 MAT在监狱中，并在释放后继续参与治疗。此外，农村和城市 人口没有比较。为了响应NIDA DAT 18 -08，我们建议进行高影响力 成瘾治疗的地理差异（GATE）研究，这将解决多层次的知识差距 影响监狱注射纳洛酮缓释剂（XR-NTX）启动的因素以及检查 释放后MAT使用和不良结果的预测因子（即，复吸、吸毒过量、累犯）， 城市POUD。这种混合方法的研究采用了社会生态框架，以了解个人 影响MAT启动和不良结局的特征，以及更远距离的背景 个体因素，包括社交网络和结构因素。GATE研究的具体目标是：1） 确定与XR-NTX启动相关的个人、个人网络和结构因素， 农村监狱，与城市相比，POUD，和2）检查个人，个人网络， 预测社区中MAT使用、治疗使用和不良结局的结构性因素 在重新进入农村，与城市相比，POUD随着时间的推移。一项前瞻性观测纵向研究 将对500名POUD进行队列研究，使用在监狱中收集的调查和社交网络数据， 在释放后6个月和12个月，以探索关键结果的多层次城乡差异。深度引导 将与POUD、监狱治疗人员和社会服务临床医生进行定性访谈。 为了最大限度地提高严谨性和可重复性，我们将采用并行三角测量策略， 和定量数据同样有助于分析，并用于交叉验证。这项研究是由一个 合格的跨学科团队，是第一个检查社会影响过程的混合方法研究 发生在农村和城市的社交网络，因为POUD从监狱过渡到地理上的多样化 个县GATE研究将提高我们在矫正环境中解决阿片类药物流行病的能力 通过为监狱内的MAT启动工作提供信息， 和释放后的护理保留，应用网络科学的研究结果，以改善重返社会的规划过程， 并为未来R级干预应用奠定基础。

ABSTRACT: As outlined in DAT18-08, NIDA has a strong interest in understanding treatment utilization among persons with opioid use disorders (POUDs) as they transition from prison to the community, because treating individuals with opioid use disorder (OUD) simultaneously improves public health and public safety. Kentucky is in the midst of an opioid crisis, with many POUDs cycling through the criminal justice system each year. While evidenced-based medications for addiction treatment (MAT) exist for treating OUD, MAT is underutilized within prisons, which elevates the risk of relapse and overdose when POUDs are released and re-enter their communities. Research is scant regarding the multi-level factors associated with offenders’ willingness to initiate MAT while in prison and their continued engagement in treatment after release. Furthermore, rural and urban populations have not been compared. In response to NIDA DAT18-08, we propose to conduct the high-impact Geographic variation in Addiction Treatment (GATE) study, which will address the knowledge gap on multi-level factors influencing prison-based extended-release injectable naltrexone (XR-NTX) initiation as well as examine predictors of post-release MAT use and adverse outcomes (i.e., relapse, overdose, recidivism) among both rural and urban POUDs. This mixed methods study employs a social ecological framework to understand individual characteristics that influence MAT initiation and adverse outcomes, as well as contexts more distal to the individual, including social networks and structural factors. The specific aims of the GATE study are: 1) to identify the individual, personal network, and structural factors associated with XR-NTX initiation in prison among rural, as compared to urban, POUDs, and 2) to examine the individual, personal network, and structural factors predicting MAT use, treatment use, and adverse outcomes in the community among re-entering rural, as compared to urban, POUDs over time. A prospective observational longitudinal cohort study will be conducted with 500 POUDs, using survey and social network data collected in prison and at 6- and 12-months post-release to explore multi-level rural-urban variation in key outcomes. In-depth guided qualitative interviews will be conducted with POUDs, prison-based treatment staff, and social service clinicians. To maximize rigor and reproducibility, we will employ a concurrent triangulation strategy, whereby qualitative and quantitative data contribute equally to the analysis and are used for cross-validation. This study is led by a qualified interdisciplinary team and is the first mixed methods study examining the processes of social influences that occur in rural and urban social networks as POUDs transition from prison back to geographically diverse counties. The GATE study will enhance our ability to address the opioid epidemic within the correctional contexts of prisons and community supervision by informing process improvement efforts for prison-based MAT initiation and post-release retention in care, applying network science findings to improve the re-entry planning process, and establishing the foundation for future R-level intervention applications.