Optimized Interventions to Prevent Opioid Use Disorder among Adolescents and Young Adults in the Emergency Department

项目摘要 全国药物使用和健康调查（NSDUH）数据显示，去年处方阿片类药物的使用 (i.e., 2019年，年龄较大的青少年和年轻人（AYAs）使用止痛药的比例分别为：19.7%（16-17岁），24.8%（16-17岁） (ages 18-25岁）和28.2%（26-29岁），而去年阿片类药物滥用（处方+非法）率为：3.4% (ages 16-17岁）、5.3%（18-25岁）和5.8%（26-29岁）。因此，AYA（16-30岁）使用阿片类药物是 需要可扩展和可持续的战略来预防阿片类药物滥用和阿片类药物使用的公共卫生问题 疾病（OUD），在卫生系统中实施的预防方法有可能改变风险 轨迹在这一补充，“阿片类药物”滥用包括处方阿片类药物（没有处方，超过 或因处方以外的原因）和使用非法阿片类药物（例如，海洛因、芬太尼类似物）。这 通过请求支持以增加参与者多样性，补充请求直接响应NS-21-025 并纳入我们正在进行的HEAL预防计划资助的随机对照试验（RCT）， 技术驱动的预防干预措施。NSDUH的数据显示，过去一年处方阿片类药物的使用和 滥用率在黑人/非裔美国人AYA中令人担忧。此外，黑人/非裔美国人 历史上在预防研究和临床试验中代表性不足，但是，考虑到OUD的种族差异， 为了获得治疗，必须让这些人充分参与。因此，我们提出了两个目标， RCT：1）增加外联，以加强对黑人/非裔美国人的AYA的包容，允许 对主持人进行有意义的分析（招募~N = 110名额外的AYA），以及2）增强我们的包容性 实施目标是对黑人/非裔美国人参与者进行深入访谈， 随访（N =20），以确定：a）未来实施该次级方案干预措施的障碍/促进因素 人口，以及B）参与者认为招募/干预措施的实施方面 吸引人和/或有帮助的，或建议修改以增加吸引力和帮助。因此，在本发明中， 更多的黑人/非洲裔美国人AYA参与这项RCT将提高普遍性和文化 干预措施与计划传播的相关性。定性方法将告知患者的小插曲 描述他们经历的旅程（从急诊室接触点到干预 交付）和成果，以便在HEAL会议和我们的实施工具包中传播。通过 作为对目前努力的补充，我们准备对阿片类药物滥用问题产生更大的影响， OUD通过加强对代表性不足的个人的包容。我们使用电子健康记录- 便利的招聘和IDI为我们的实施工具包提供信息，是支持未来 将我们的技术驱动的预防干预措施纳入医疗保健系统。

Project Summary National Survey on Drug Use and Health (NSDUH) data show that past-year prescription opioid use (i.e., pain relievers) in 2019 for older adolescents and young adults (AYAs) was: 19.7% (ages 16-17), 24.8% (ages 18-25), and 28.2% (ages 26-29), whereas past-year opioid misuse (prescription+illicit) rates were: 3.4% (ages 16-17), 5.3% (ages 18-25), and 5.8% (ages 26-29). Thus, use of opioids by AYAs (ages 16-30) is a public health concern requiring scalable and sustainable strategies to prevent opioid misuse and opioid use disorders (OUDs), and prevention approaches implemented in health systems have the potential to alter risk trajectories. In this supplement, “opioid” misuse includes prescription opioids (without a prescription, more than prescribed, or for reasons other than prescribed) and use of illicit opioids (e.g., heroin, fentanyl analogs). This supplement request is directly responsive to NS-21-025 by requesting support to increase participant diversity and inclusion in our ongoing HEAL Prevention Initiative-funded randomized controlled trial (RCT) to technology-driven prevention interventions. The NSDUH data show that past-year prescription opioid use and misuse rates are concerning among Black/African American AYAs. Further, Black/African Americans are historically under-represented in prevention research and clinical trials, but, given racial disparities in OUD treatment access, it is critical to fully engage these populations. Thus, we propose two aims related to our RCT: 1) Increase outreach to enhance inclusion of AYAs who identify as Black/African American, permitting meaningful analyses of moderators (enrolling ~N = 110 additional AYAs), and 2) Enhance inclusion in our implementation aim by conducting in-depth interviews (IDIs) with Black/African American participants after follow-up (N =20) to identify: a) barriers/facilitators to future implementation of interventions for this sub- population, and b) aspects of the recruitment/intervention delivery that were perceived by participants as engaging and/or helpful or recommendations for modifications to increase appeal and helpfulness. Thus, greater involvement of Black/African American AYAs in this RCT will enhance the generalizability and cultural relevance of the interventions for planned dissemination. Qualitative methods will inform vignettes of patient journeys that characterize their experiences (from the Emergency Department touchpoint through intervention delivery) and outcomes for dissemination at HEAL meetings and in our implementation toolkit. By supplementing current efforts, we are poised to have a greater impact on the problem of opioid misuse and OUD through enhanced inclusion of under-represented individuals. Our use of electronic health record- facilitated recruitment and IDIs to inform our implementation toolkit are key innovations that support future integration of our technology-driven prevention interventions in healthcare systems.