Linkage navigation to enhance initiation and engagement in treatment for opioid use disorder to prevent overdose.

项目摘要 拟议研究的总体目标是开发，试点和评估联动导航计划 加强阿片类药物使用障碍（OUD）治疗的启动和参与，以防止过量。到目前为止， 支持识别患有OUD的个体并将其与治疗联系起来的策略的经验证据很少。之一 最有希望的策略包括将急诊科（艾德）确定的患者启动到 丁丙诺啡，然后将他们转介到初级保健部门接受持续治疗。然而，这种干预是 依赖于在艾德就诊时表现出中度至重度阿片类戒断体征的患者，或 带着丁丙诺啡让病人出院进行自我诱导干预也依赖于忙碌艾德 参与诱导和转诊过程以进行持续治疗的提供者。在初审中， 治疗包括与研究助理进行10至15分钟的简短谈判访谈。另一种选择， 也许更可持续的方法是将艾滋病毒预防与护理模式联系起来， 促进OUD患者的识别和与治疗的联系，使用干预措施，重点是 转诊至治疗部分，无论他们是否在治疗中接受丁丙诺啡治疗， ED.鉴于2017年全国阿片类药物过量的艾德就诊增加了30%， 在艾德是必不可少的我们的多学科团队汇集了多年的物质使用经验 研究，急诊医学，干预开发和评估，成瘾医学，患者 导航和临床护理，以解决以下具体目标：1）制定干预措施，以提高 与阿片类药物使用障碍患者开始和参与治疗的联系; 2）评估 干预措施的可接受性、可行性和初步疗效，以加强与启动和保留的联系， 与单独的临床医生转诊相比，阿片类药物使用障碍患者的治疗加临床医生转诊。 鉴于艾滋病毒和OUD之间的相似性，我们将采用循证抗逆转录病毒治疗， 获得服务（ARTAS）协议，以加强OUD患者与阿片类激动剂治疗的联系。 我们将进行一项定性研究，其中包括与滥用阿片类药物的人进行的关键线人访谈， 治疗和临床提供者以及患者导航员，以告知ARTAS的基本修改， 有必要加强与OUD治疗的启动和保留的联系。信息从 访谈将增加先前的文献和其他基于证据的模型，以完成试点 干预我们将在患有中度至重度阿片类药物使用障碍的个体中试点开发干预措施 他们目前没有接受治疗。我们将从丹佛健康艾德招募108名参与者， 使用区组随机化设计，将干预（n = 58）与标准治疗（n=58）进行比较。我们的主要成果将是 随机化后30天内开始治疗，次要结局包括治疗 一个月和三个月时的参与、阿片类药物使用天数、非致命性过量和致命性过量。

PROJECT SUMMARY The overarching goal of the proposed research is to develop, pilot, and evaluate a linkage navigation program to enhance initiation and engagement in treatment for opioid use disorder (OUD) to prevent overdose. To date, empirical evidence to support strategies to identify and link individuals with OUD to treatment is sparse. One of the most promising strategies involves initiating patients identified in emergency department (ED) settings onto buprenorphine, then referring them for ongoing treatment in primary care. However, this intervention is dependent on patients exhibiting signs of moderate to severe opioid withdrawal when they present to the ED or discharging the patient with buprenorphine for self-induction. The intervention is also dependent on busy ED providers engaging in the process of induction and referral for ongoing treatment. In the initial trial, referral to treatment consisted of a 10 to 15 minute brief negotiation interview with a research associate. An alternative, and perhaps more sustainable, approach could be to apply the linkage to care models from HIV prevention to facilitate identification and linkage of individuals with OUD to treatment using an intervention that focuses on the referral to treatment component, irrespective of whether or not they are inducted onto buprenorphine in the ED. Given the 30% increase in ED visits for opioid overdose across the country in 2017, targeting interventions in the ED is essential. Our multidisciplinary team brings together years of experience in substance use research, emergency medicine, intervention development and evaluation, addiction medicine, patient navigation, and clinical care to address the following specific aims: 1) To develop an intervention to enhance linkage to initiation and engagement in treatment for individuals with opioid use disorder and 2) To assess acceptability, feasibility, and initial efficacy of an intervention to enhance linkage to initiation and retention in treatment for individuals with opioid use disorder plus clinician referral compared to clinician referral alone. Given the similarities between HIV and OUD, we will adapt the evidence-based Anti-Retroviral Treatment and Access to Services (ARTAS) protocol to enhance linkage of individuals with OUD to opioid agonist treatment. We will conduct a qualitative study that includes key informant interviews with persons who misuse opioids, treatment and clinical providers, and patient navigators to inform the essential modifications to ARTAS that would be necessary to enhance linkage to initiation and retention in treatment for OUD. Information from the interviews will be augmented with prior literature and other evidence-based models to finalize the pilot intervention. We will pilot the developed intervention in individuals with moderate to severe opioid use disorder who are not currently in treatment. We will recruit 108 participants from the Denver Health ED to compare the intervention (n=58) to standard of care (n=58) using a block randomization design. Our primary outcome will be treatment initiation within 30 days of randomization and secondary outcomes will include treatment engagement at one and three months, number of opioid use days, non-fatal overdose, and fatal overdose.