Reducing Opioid Mortality in Illinois (ROMI)

项目摘要 2017年，超过2，700名伊利诺伊州居民死于阿片类药物过量-这一数字超过了该州 交通事故和枪击杀人的死亡人数离开监狱和监狱的个人可能最高 致命过量和其他药物相关危害的风险。极度脆弱的男性和女性面临着这些风险， 恰恰是在他们跨越支离破碎的刑事司法、社会服务和公共卫生的界限时， 因此，最容易失去后续行动和脱离服务，或有其他 基本需求无人照顾。对于那些在监狱中快速流动的被拘留者来说，挑战可能最为严峻 环境，不可预测的离职阻碍出院计划和护理协调， 利益攸关方可能持有鄙视药物使用或抵制减少危害干预措施的态度。 个人返回到芝加哥社区的颜色是附近相对丰富的资源， 减少伤害。然而，他们必须通过非法毒品分销的中心， 海洛因、芬太尼和其他合成阿片类药物过量致死的发生率。南方农村人口 伊利诺伊州，可能有很长的旅行距离，从任何美沙酮设施或任何DEA豁免的医生提供， 开丁丙诺啡农村患者在提供纳洛酮和SSP方面也面临地理障碍。 许多减少危害服务的设计和实施都是为了在传统的 阿片类药物使用中心此类农村服务的可接受性和文化能力仍然没有得到充分研究。 我们提议的多中心ROMI试验（降低伊利诺伊州阿片类药物死亡率）旨在解决这一公共卫生问题 通过改善对药物辅助治疗（MAT）、纳洛酮的支持和服务联系， 分发和注射器支持服务（SSP）提供给与阿片类药物使用有关的个人 紊乱我们试图测试是否有一个统一的案例管理方法，包括同行恢复教练 在五个不同的城市和农村环境中， 阿片类药物紊乱、过量和相关危害的发生率很高。 我们申请资金实施一项五个地点的随机对照试验，至少招募1,000人 与OUD一起生活ROMI试验将采用轴辐式模式进行，集中的长时间， 社区外展干预项目（COIP）的常设社会服务基础设施， 伊利诺伊大学芝加哥分校（UIC）。《刑事组织法组织法》提供案件管理/将护理服务移交司法- * 使类阿片使用者参与，将资源和技术援助扩大到人口较少的受影响最严重的农村地区 阿片类药物的流行使用混合型1的有效性实施设计，我们提出了一个简单的，但 有效的一揽子治疗和减少危害干预措施，以减少随后的类阿片使用和相关的 在不同背景下的危害。因此，我们务实的审判是很好的定位，以测试有效性，同时收集 用于实施的上下文数据。

PROJECT ABSTRACT More than 2,700 Illinois residents died of opiate overdose in 2017—a number that surpassed the state’s combined fatalities from road accidents and gun homicide. Individuals leaving jail and prison may be at highest risk of fatal overdose and other drug-related harms. Severely vulnerable men and women face these risks at precisely the moment they cross boundaries of fragmented criminal justice, social service, and public health systems, and are thus most vulnerable to lost follow-up and disengagement from services, or to have other basic needs left unattended. The challenge may be most acute for detainees who rapidly flow through jail settings, where unpredictable departures hinder discharge planning and care coordination, and where justice stakeholders may hold attitudes that stigmatize substance use or resistant to harm reduction interventions. Individuals returning to Chicago communities of color are near relatively rich resources for both treatment and harm reduction. Yet they must navigate epicenters of illicit narcotics distribution that feature particularly high incidence of fatal overdose from heroin, fentanyl, and other synthetic opioids. Rural individuals in Southern Illinois, may have long travel distances from any methadone facility or any DEA-waivered physician available to prescribe buprenorphine. Rural patients also face geographic barriers to the provision of naloxone and SSPs. Many harm reduction services have been designed and implemented to serve urban populations in traditional centers of opioid use. The acceptability and cultural competence of such rural services remains understudied. Our proposed multi-site ROMI trial (Reducing Opioid Mortality in Illinois) seeks to address this public health challenge through improved supports and service linkages to medication-assisted treatment (MAT), naloxone distribution, and syringe support services (SSPs) provided to justice-involved individuals living with opioid use disorders. We seek to test whether a unified case management approach that includes peer recovery coaches can improve treatment engagement and retention in five diverse urban and rural contexts that all experience high rates of opioid disorders, overdose, and related harms. We request funds to implement a five-site Randomized Controlled Trial, enrolling at least 1,000 individuals living with OUD. The ROMI trial will be carried out using a hub-and-spoke model, with centralized long- standing social services infrastructure at the Community Outreach Intervention Projects (COIP) hosted at the University of Illinois at Chicago (UIC). COIP provides case management/transition of care services to justice- involved opioid users, extending resources and technical assistance to less-populated rural areas hardest-hit by the opioid epidemic. Using a hybrid type-one effectiveness implementation design, we propose a simple but effective package of treatment and harm reduction interventions to reduce subsequent opioid use and related harms in diverse contexts. Our pragmatic trial is thus well-positioned to test effectiveness while collecting contextual data for implementation.