Project 2: Prevention of Opioid Overdose following Incarceration Leveraging Mobile Health Technology

项目摘要/摘要 致命的阿片类药物过量在过去十年中急剧增加。被监禁的男人和女人有一个 有阿片类药物使用史的人在重新进入社区时服药过量的风险很高。一种有效的方法 需要预防服药过量并将其与监禁后的社区药物使用治疗联系起来。 刑事司法环境是实施阿片类药物过量预防干预的理想场所，因为 高危人群比率高以及重新进入社区后的教育和干预机会 社区。然而，这种环境对实施和维持构成了重大的结构性障碍 干预措施。移动技术的使用为克服这些障碍提供了一种创新的方法 防止高危男女在入狱后重新进入社区时过量服用阿片类药物。 这项研究将是第一阶段的试点和可行性研究，将首先使用移动技术工具来防止 监禁后的阿片类药物过量。拟议的研究旨在开发和测试两个移动平台：(A) 移动健康应用干预(MAI)；以及(B)短信干预(SMS)，并将它们进行比较 到标准护理(SOC)。这两种干预措施都将使用激励性访谈和减少伤害技能培训 在获释之前。提出的预防阿片类药物过量的方法预计将是 高效和易于传播的平台，将促进与社区资源的联系，增加 关于预防阿片类药物过量和预防阿片类药物发生的知识和行为技能 在一个特别脆弱的时期，关键人群中的服药过量。三个阶段，自上而下 将进行适应、改进和中试干预措施的研究方法。第一阶段将包括 与刑事司法环境中的目标人群和主要利益攸关方进行个人访谈(IDI)以告知 干预发展及实施策略。第二阶段将包括移动设备的开发 干预技术。我们将进行Beta测试和一系列IDI，目标人群和关键 利益攸关方告知干预措施的反复修订。在第三阶段，我们将评估可行性， 移动技术工具在阿片类药物高危人群中的可接受性和初步疗效 服药过量后再次进入社区后，通过三臂(MAI与SMS与SOC)随机对照研究 有90名参与者的对照试验。将收集有关最近吸毒、过量服药危险行为、 以及在1个月、3个月、6个月和12个月的后续行动中与以社区为基础的药物使用服务的联系。通过IDI， 我们将探索：(1)表现出高干预使用模式的个体之间的差异 技术和使用模式较低的技术；(2)与实施和 在刑事司法背景下的可持续性；以及(3)结果与使用 干预技术。该项目在预防阿片类药物过量方面具有重要意义 并更好地了解两种移动健康干预模式的效用。

Project Summary/Abstract Fatal opioid overdoses have increased dramatically over the past decade. Incarcerated men and women with a history of opioid use are at high-risk for overdose upon re-entry into the community. Effective methods of overdose prevention and linkage to community-based substance use treatment post-incarceration are needed. The criminal justice setting is an ideal location to implement opioid overdose prevention interventions due to the high rates of at-risk populations and the opportunities for education and intervention upon re-entry into the community. However, this setting poses significant structural barriers to implementing and sustaining interventions. The use of mobile technology offers an innovative approach to overcoming these barriers and preventing opioid overdose among at-risk men and women upon re-entry into the community post-incarceration. This study will be a Stage I pilot and feasibility study that will be the first to use mobile technology tools to prevent opioid overdose following incarceration. The proposed study seeks to develop and test two mobile platforms: (a) mobile health application intervention (MAI); and (b) text messaging intervention (SMS) and will compare them to standard of care (SOC). Both interventions will use motivational interviewing and harm reduction skills training prior to release from incarceration. The proposed method of opioid overdose prevention is expected to be an efficient and easily disseminable platform that will facilitate linkage to community-based resources, increase knowledge and behavioral skills regarding opioid overdose prevention, and prevent the occurrence of opioid overdose among a key population during a particularly vulnerable period of time. A three-phase, top-down research approach to adapt, refine, and pilot test the interventions will be conducted. Phase 1 will include individual interviews (IDIs) with the target population and key stakeholders in the criminal justice setting to inform intervention development and the implementation strategy. Phase 2 will include development of the mobile intervention technologies. We will conduct a beta test and a series of IDIs with the target population and key stakeholders to inform iterative revision of the interventions. During Phase 3, we will evaluate the feasibility, acceptability, and preliminary efficacy of the mobile technology tools among men and women at-risk for opioid overdose upon re-entry into the community post-incarceration via a 3-armed (MAI vs. SMS vs. SOC) randomized controlled trial with 90 participants. Data will be collected regarding recent drug use, overdose risk behaviors, and linkage to community-based substance use services at 1-, 3-, 6- and 12-month follow-ups. Through IDIs, we will explore: (1) the difference between individuals who demonstrate high usage patterns of the intervention technologies and those with low usage patterns; (2) barriers and facilitators related to implementation and sustainability within the criminal justice setting; and (3) the relationship between outcomes and usage of the intervention technologies. The project is significant in regards to its potential to prevent opioid overdose among criminal justice populations and gain greater understanding of the utility of two mhealth intervention modalities.