A Rigorous Evaluation of the Opioid Intervention Court Strategy- A Public Health Response

阿片类药物过量死亡人数的急剧上升使美国各地的社区不堪重负。本研究将 对全国第一个被称为阿片类药物干预法庭的“公共卫生法庭”进行严格评估 (OIC)该模型于2017年5月在纽约州布法罗建立。这项建议的研究目的是 评估与当地公共卫生部门合作实施的这一战略， 公共安全和司法系统的反应。根据协议备忘录，申请人是完全合伙人， 纽约州伊利县卫生部代表伊利县阿片类药物流行特别工作组 （ECOETF），包括纽约统一法院系统，第八司法区。卫生专员， 博士Gale Burstein作为调查员全面参与，他是正在实施的ECOETF的主任。 应对类阿片流行病的战略，包括伊斯兰会议组织模式。 OIC模式是对三名毒品法庭被告在第二次吸毒前致命过量的公共卫生反应。 在2016年的一周内出庭，这表明传统的毒品法庭模式（每周一次） 需要修改以挽救生命。OIC模式旨在让非暴力用户进入 在被捕后数小时内接受治疗而不是数周。它要求每天与法官报到，重点是 立即药物辅助治疗（MAT）和阿片类药物使用障碍治疗（公共卫生方法 以挽救生命），一旦稳定，将参与者转移到传统的每周毒品法庭。 必须指出，伊斯兰会议组织的这一模式已成为其他地方采用这种模式的催化剂， 将公共卫生办法创新性地纳入禁毒法庭的应对措施。然而，迄今为止， 严格评估其有效性。使用准实验研究设计，我们将比较 阿片类药物干预法庭参与者的结果与对照组的参与者参加了一个 传统的药物治疗法庭。具体而言，我们将实现以下目标：目标1：治疗 影响-基于OIC与tDTC检查至治疗开始时间的差异，并检查 物质使用随时间的变化（即，类阿片使用、其他非法药物使用、酒精使用和烟草） OIC与tDTC的基础;目标2：健康影响-检查心理健康的变化（例如，症状 抑郁症，由于心理健康导致的角色限制）和身体健康（例如，疼痛，由于身体原因导致的角色限制 目标3：恢复的影响-审查社会领域的变化 以及与恢复有关的环境因素（例如，住房稳定性、就业、社会联系）;以及， 目标4：司法影响-利用法庭记录审查与司法有关的结果（例如，坚持出庭 根据OIC对个人的任命、与毒品有关的逮捕、与毒品无关的逮捕、监禁） vs. tDTC。从这项研究的结果将回答有关的关键问题，翻译的国家第一个“公共” 卫生法庭”，并将告知未来的做法和政策，以解决这一危机，注入公共卫生到 公共安全和司法系统。

The dramatic rise in opioid overdose fatalities is overwhelming communities across the US. This study will conduct a rigorous evaluation of the nation's first “public health court” known as the Opioid Intervention Court (OIC) model that was established in Buffalo, NY, in May 2017. The research objective of this proposal is to evaluate this strategy implemented in collaboration with local public health to infuse public health into the public safety and justice system response. Under Memorandum of Agreements, the applicant is fully partnered with the Erie County, NY Department of Health on behalf of the Erie County Opioid Epidemic Task Force (ECOETF) that includes the New York Unified Court System, 8th Judicial District. The Commissioner of Health, Dr. Gale Burstein, is fully involved as an investigator and is the Director of the ECOETF that is implementing strategies to address the opioid epidemic, including the OIC model. The OIC model was a public health response to three drug court defendants fatally overdosing before their 2nd court appearance in a single week in 2016, indicating that the traditional drug court model (with weekly appearances) needed to be modified to save lives. The OIC model was designed to get non-violent users into treatment within hours of their arrest instead of weeks. It requires daily check-ins with the judge, focuses on immediate Medication Assisted Treatment (MAT) and opioid use disorder treatment (a public health approach to save lives) and once stable, transfers participants to the traditional weekly drug courts. It is important to note that this OIC model has served as a catalyst for other localities to adopt such an innovative infusion of public health approaches into the drug court response. However, to date, there has not been a rigorous evaluation of its effectiveness. Using a quasi-experimental research design, we will compare outcomes of Opioid Intervention Court participants with a comparison group of participants enrolled in a traditional Drug Treatment Court (tDTC). Specifically, we will address the following aims: Aim 1: Treatment Impact- To examine differences in time to treatment initiation on the basis of OIC vs. tDTC and to examine changes in substance use over time (i.e., opioid use, other illicit drug use, alcohol use and tobacco) on the basis of the OIC vs. tDTC; Aim 2: Health Impact- To examine changes in mental health (e.g., symptoms of depression, role limitations due to mental health) and physical health (e.g., pain, role limitations due to physical health) over time on the basis of the OIC vs. tDTC; Aim 3: Recovery Impact- To examine changes in social and environmental factors related to recovery (e.g., housing stability, employment, social connectedness); and, Aim 4: Justice Impact- To use court records to examine justice related outcomes (e.g., adherence to court appointments, drug related arrests, non-drug related arrests, incarceration) for individuals on the basis of OIC vs. tDTC. Results from this study will answer key questions related to the translation of the nation's first “public health court” and will inform future practice and policy to address this crisis by infusing public health into the public safety and justice system.