Community-Based Intervention at Needle Exchange Sites

描述（由申请人提供）：基于社区的注射器交换计划（SEP）的参与者的注射药物使用率超过了其他物质使用者人群中报告的注射药物使用率（Wood等人，2007年）。我们小组先前的工作表明，结合动机和行为干预的组合方法与美沙酮治疗登记率的增加和药物使用率和其他高风险行为的减少有关（Kidorf & Brooner，2006）。毫无疑问，与其他来源的转诊相比，SEP的转诊在美沙酮治疗中取得了更差的结果，包括更高的药物使用率和流失率（Kidorf & Brooner，2006）。拟议的5年竞争延续应用程序扩展了我们以前的工作，通过评估基于步进的诱导策略，以改善保留和其他结果的注射器交换器进入美沙酮治疗。对美沙酮治疗感兴趣的阿片类药物依赖性巴尔的摩针头交换（BNEP）参与者（n = 520）将完成一组临床评估，并随机分配至三种3个月治疗诱导策略之一。第一种是低阈值诱导（LTSC），其广泛地以中期美沙酮维持为模型（Schwartz等人，2006年），旨在更逐步过渡SEP参与者的日常结构的维持治疗，同时最大限度地暴露于美沙酮药物治疗。第二种是基于代金券的干预，使用货币激励措施来加强美沙酮给药和阶梯式咨询时间表的治疗参与。最终条件（RSC）将使参与者接受常规分步护理。所有条件下的受试者将在参与的最后3个月内接受常规阶梯式护理。所有受试者将接受美沙酮（90 mg）稳定治疗，并每周随访6个月。将在各种情况下使用结构化的再入院干预措施，以重新吸引因吸毒而离开治疗的参与者（Brooner和Kidorf，2002年）。尿潴留、药物使用（尿分析和自我报告）和其他风险行为是主要的结局指标。中介模型将评估治疗准备和满意度变化的影响，作为结果的预测因素。这些研究结果将为该领域提供循证策略，以优化美沙酮对这一重要的注射阿片类药物使用者亚组的治疗效果。

DESCRIPTION (provided by applicant): Participants in community-based syringe exchange programs (SEPs) engage in rates of injection drug use that exceed those reported in other populations of substance users (Wood et al., 2007). Prior work by our group has shown that a combination approach incorporating motivational and behavioral interventions is associated with increased rates of methadone treatment enrollment and reduced rates of drug use and other high risk behaviors (Kidorf & Brooner, 2006). Neverthleless, referrals from the SEP achieved worse outcomes in methadone treatment compared to those referred from other sources, including higher rates of drug use and attrition (Kidorf & Brooner, 2006). The proposed 5-year competing continuation application extends our previous work by evaluating stepped-based induction strategies to improve retention and other outcomes of syringe exchangers entering methadone treatment. Opioid-dependent Baltimore Needle Exchange (BNEP) participants (n = 520) that express interest in methadone treatment will complete a clinical assessment battery and be randomly assigned to one of three 3-month treatment induction strategies. The first is a low threshold induction (LTSC) that is broadly modeled on interim methadone maintenance (Schwartz et al., 2006) and designed to more gradually transition SEP participants to the daily structure of maintenance treatment while maximizing exposure to methadone pharmacotherapy. The second is a voucher-based intervention that uses monetary incentives to reinforce treatment engagement to schedules of methadone dosing and stepped-based counseling. The final condition (RSC) will expose participants to routine stepped-care. Participants in all conditions will receive routine stepped care during the final 3-months of participation. All participants will be stabilized on methadone (90 mg) and followed weekly for 6-months. A structured readmission intervention will be used across conditions in efforts to re-engage participants leaving treatment in the context of drug use (Brooner & Kidorf, 2002). Retention, drug use (urinalysis and self-report), and other risk behaviors are the primary outcome measures. Mediational models will evaluate the impact of changes in treatment readiness and satisfaction as predictors of outcome. These findings will inform the field on evidenced-based strategies to optimize methadone treatment effectiveness for this important subgroup of injection opioid users.