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：正如DAT18-08中概述的那样，NIDA对了解以下人群的治疗利用情况非常感兴趣 阿片类药物使用障碍(POUD)患者从监狱过渡到社区，因为治疗 阿片类药物使用障碍(OUD)患者同时改善公共健康和公共安全。肯塔基州 正处于阿片类药物危机之中，每年有许多POUD在刑事司法系统中循环。而当 基于证据的成瘾治疗药物(MAT)存在用于治疗OUD的药物，MAT在 监狱，当POUD被释放并重新进入监狱时，这会增加复发和过量服药的风险 社区。关于与犯罪者主动提出意愿相关的多层次因素的研究还很缺乏 他们被关押在监狱中，并在获释后继续接受治疗。此外，农村和城市 还没有对种群进行比较。针对NIDA DAT18-08，我们建议进行高影响 成瘾治疗中的地理差异(GATE)研究，将解决多层次的知识差距 监狱缓释注射纳曲酮(XR-NTX)起效及检查的影响因素 两地农村居民服用避孕药后的使用和不良后果(如复发、过量用药、再犯罪)的预测因素 和城市POUD。这项混合方法研究使用了一个社会生态框架来理解个体 影响MAT启动和不良结果的特征，以及更远端的环境 个人，包括社会网络和结构性因素。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， 和结构性因素预测社区中垫子的使用、治疗的使用和不良后果 在重新进入农村的人中，与城市相比，随着时间的推移，POUD。一个前瞻性的纵向观测 将对500名POUD进行队列研究，使用在监狱和医院收集的调查和社交网络数据 在6个月和12个月后释放，以探索关键结果的多层次城乡差异。深度指导 定性访谈将与POUD、监狱治疗人员和社会服务临床医生进行。 为了最大限度地提高精确度和重复性，我们将采用并行三角剖分策略，从而定性地 定量数据同样有助于分析，并用于交叉验证。这项研究由一位 合格的跨学科团队，是考察社会影响过程的第一个混合方法研究 随着POUD从监狱回到地理上的多样化，这种情况发生在农村和城市的社交网络中 各县。GATE研究将加强我们在惩教背景下处理阿片类药物流行的能力 通过通知监狱垫子启动的过程改进努力，加强监狱和社区监督 以及释放后在照护中的保留，应用网络科学发现来改进重返社会的规划过程， 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.