Impact of PTSD and trauma reexposure on buprenorphine maintenance treatment in syringe exchange programs

在美国，阿片类药物使用障碍（OUD）和过量死亡正在增加;然而， 80%的OUD患者仍然无法接受治疗。在33个州运作，注射器交换 向注射者提供无菌注射器和其他卫生服务的SEPs 毒品，是接触脱离治疗的类阿片使用者的一个关键渠道。在一项为期24周的随机 基于OUD和HIV高发病率的大城市地区的对照试验，Project BLOOM （R 01 DA 044878，[PI：Fox]）将招募250名使用SEP的阿片类药物使用者， 按1：1随机分配至现场丁丙诺啡治疗（O-BMT）或加强转诊。两个多 几周后，O-BMT条件的参与者将在现场看到两次丁丙诺啡提供者， 接受每周一次的药物包，然后他们的护理将被转移到社区健康中心， 丁丙诺啡维持治疗中心拟议的多样性补充将 支持Teresa López-Castro博士，临床心理学家和早期研究者， 研究参与丁丙诺啡治疗的障碍， 创伤性应激障碍（PTSD）和创伤事件再暴露。布卢姆计划 确定了OUD治疗的结构性障碍，并正在测试基于SEP的丁丙诺啡启动 以此来减少丁丙诺啡治疗的延迟然而，PTSD和 经历新的创伤性事件（创伤性事件再暴露）是非常常见的 在OUD患者中，影响药物使用行为，并可能改变O-BMT的效果。 因此，设计新的参与和治疗策略需要考虑创伤后应激障碍， 创伤事件再暴露拟议的混合方法研究有两个目的： (1)定量评估创伤后应激障碍和创伤事件再暴露对 O-BMT的有效性;（2）从利益相关者（SEP消费者）收集定性数据 （c）关于注射吸毒者与创伤后应激障碍有关的治疗需要的信息。两年多样性 补充将创造关于创伤后应激障碍和创伤性事件如何重新 暴露影响丁丙诺啡治疗功效。该申请还提出了一个 全面的职业发展计划，也将支持洛佩斯-卡斯特罗博士的进一步发展。 发展成为临床研究者。

In the United States, opioid use disorder (OUD) and overdose deaths are increasing; yet 80% of people with OUD remain out of treatment. Operating in 33 states, syringe exchange programs (SEPs), which provide sterile syringes and other health services to people who inject drugs, are a key venue to reach out-of-treatment opioid users. In a 24-week randomized controlled trial based in a large urban area with high rates of OUD and HIV, Project BLOOM (R01DA044878, [PI: Fox]) will recruit 250 out-of-treatment opioid users who utilize SEPs and randomize 1:1 to onsite buprenorphine treatment (O-BMT) or enhanced referral. Over two weeks, participants in the O-BMT condition will see a buprenorphine provider twice onsite, receive weekly medication packs, and then their care will be transferred to a community health center for maintenance buprenorphine treatment. The proposed diversity supplement will support Dr. Teresa López-Castro, a clinical psychologist and early-stage investigator, to study barriers to engagement in buprenorphine treatment that are related to Post- Traumatic Stress Disorder (PTSD) and traumatic event re-exposure. Project BLOOM has identified structural barriers to OUD treatment and is testing SEP-based buprenorphine initiation as a way to minimize delays in starting buprenorphine treatment. However, PTSD and the experiencing of new traumatic events (traumatic event re-exposure) are exceedingly common among people with OUD, affect drug use behaviors, and will likely modify O-BMT’s effects. Thus designing novel engagement and treatment strategies requires consideration of PTSD and traumatic event re-exposure. The objectives of the proposed mixed methods study are two-fold: (1) to quantitatively evaluate the moderating effect of PTSD and traumatic event re-exposure on the efficacy of O-BMT; and (2) to collect qualitative data from stakeholders (SEP consumers and staff) on the PTSD-related treatment needs for IDUs. The proposed two-year diversity supplement will create generalizable knowledge regarding how PTSD and traumatic event re- exposure impact buprenorphine treatment efficacy. The application also proposes a comprehensive career development plan that will also support Dr. López-Castro’s further development as a clinical investigator.