Data-Driven Approaches for Opioid Use Disorder Treatment, Recovery, and Overdose Prevention in Rural Communities via Mobile Health Clinics and Peer Support Services

在过去的一年里，超过10万人因药物过量而丧生，其中80%涉及阿片类药物。尽管 阿片类药物使用障碍（MOUD）药物在减少阿片类药物滥用和过量风险方面的有效性，只有10%的 有需要的人得到治疗。此外，治疗保留率较低（30-50%），一半的患者经历了 阿片类药物使用复发同伴支持专家（PSS），他们是具有直接经验和成功经验的个人 从物质使用障碍中恢复，可以提供社会支持，直接解决治疗和恢复障碍， 阿片类药物使用障碍（OUD）。我们的系统回顾显示，接受PSS的OUD患者 干预更有可能启动MOUD，但仍有证据表明MOUD保留或阿片类药物使用有效 不确定对于农村人口来说，开放式腹泻的低治疗启动率和保持率尤其令人担忧， 服务不足的社区，他们很少有机会接触到可以开MOUD的临床医生， 获得护理的障碍，包括社会支持有限、缺乏保险、无家可归、交通问题和耻辱。给定 这些人群也处于阿片类药物过量的高风险之中，原因是许多相同的因素， 在农村和医疗服务不足社区增加OUD治疗、保留和过量预防， needed.移动的卫生诊所是及时提供干预措施的有效和多功能工具，包括 那些用于OUD治疗的人，医疗服务不足和风险社区。然而，有效的干预措施， OUD治疗的启动、保留和过量预防尚未在MHC环境中进行探索。我们的目标 建议增加MOUD治疗开始，治疗保留，并防止药物过量死亡。 通过开发、测试、交付和评估创新的1）PSS， 干预措施，以提高农村和服务不足人口的MOUD启动率和保留率; 2）建模 优先考虑高危社区提供MHC的框架（基于预防的过量死亡）。研究表明 这种建模框架可以大大提高其他疾病的资源分配效率。的 PSS干预和建模框架将在R61阶段（R61目标1和2）制定，并在 R33阶段，系统地向最优先的社区（通过以下方式确定）提供具有PSS服务的MHC 在南卡罗来纳州（SC）进行MOUD治疗（MOUD），以增加MOUD治疗的开始、保持和过量预防。在 在R33阶段，我们将进行一项随机对照试验（RCT），以评估PSS干预的有效性 组件（R33目标1），并扩展我们在R61阶段开发的建模框架，以便a）评估 PSS干预对预防致命性过量的人群影响和成本效益（R33目标2a）和B） 探索MHC方案的改进，以提高基于MHC的OUD干预措施的有效性（R33 目标2b）。随着阿片类药物过量死亡人数在过去2年中翻了一番全国和SC，没有迹象表明， 疫情正在放缓。我们的可持续框架有可能防止数百至数千例阿片类药物过量 仅在自然科学领域，就可以扩大到其他区域，以拯救更多的生命。

Over 100,000 lives were lost due to drug overdose in the past year, of which 80% involved opioids. Despite the effectiveness of medications for opioid use disorder (MOUD) at reducing opioid misuse and risk of overdose, only 10% of people in need receive treatment. Moreover, treatment retention is low (30-50%) with half of patients experiencing an opioid use recurrence. Peer support specialists (PSSs), who are individuals with direct experience with and successful recovery from Substance Use Disorder, can offer social support and directly address treatment and recovery barriers for individuals with Opioid Use Disorder (OUD). Our systematic review showed that OUD patients receiving a PSS intervention were more likely to initiate MOUD, but evidence of effectiveness for MOUD retention or opioid use remain inconclusive. Low treatment initiation and retention rates for OUD are especially concerning for rural populations and underserved communities, who rarely have access to clinicians who can prescribe MOUD and experience substantial barriers to care, including limited social support, lack of insurance, homelessness, transportation issues, and stigma. Given that these populations are also at an elevated risk of opioid overdose due to many of these same factors, interventions to increase OUD treatment, retention, and overdose prevention in rural and medically underserved communities are urgently needed. Mobile health clinics (MHC) are an effective and versatile tool for timely delivery of interventions, including those for OUD treatment, to medically underserved and at-risk communities. However, effective intervention delivery for OUD treatment initiation, retention, and overdose prevention have not been explored in MHC settings. The goal of our proposal is to increase MOUD treatment initiation, treatment retention, and prevent overdose deaths in medically underserved communities (via MHC) through development, testing, delivery, and evaluation of an innovative 1) PSS intervention to increase MOUD initiation and retention rates in rural and underserved populations and 2) modeling framework to prioritize at-risk communities for MHC delivery (based on overdose deaths prevented). Research has shown that such modeling frameworks can drastically increase the efficiency of resource allocation efforts for other diseases. The PSS intervention and modeling framework will be developed in the R61 phase (R61 Aims 1 and 2) and implemented in the R33 phase to systematically deliver MHCs with PSS services to the highest priority communities (identified via modeling) in South Carolina (SC) in order to increase MOUD treatment initiation, retention, and overdose prevention. In the R33 phase, we will conduct a randomized controlled trial (RCT) to evaluate the effectiveness of the PSS intervention component (R33 Aim 1), and extend our modeling framework developed in the R61 phase in order to a) evaluate the population impact and cost-effectiveness of the PSS intervention on preventing fatal overdose (R33 Aim 2a) and b) explore improvements to MHC protocols in order to increase effectiveness of MHC-based interventions for OUD (R33 Aim 2b). With opioid overdose deaths doubling over the past 2 years nationally and in SC, there are no signs that the epidemic is slowing down. Our sustainable framework has potential to prevent hundreds to thousands of opioid overdoses in SC alone, and can be scaled up in other regions to save many more lives.