Western States Node of the National Drug Abuse Treatment Clinical Trials Network

摘要 国家药物滥用治疗临床试验的西部州节点(WSN)研究议程 网络(CTN)竞争性更新测试干预措施，以填补成瘾护理级联中的空白，其中 越来越少的吸毒者参与治疗，接受药物治疗，被保留在护理中， 并经历持续的复苏。该节点建议继续保持两国之间的成功伙伴关系 俄勒冈健康与科学大学(OHSU；托德·科萨斯，MPI)和加州大学旧金山分校 (加州大学旧金山分校；詹姆斯·索伦森，Co-I)，并将斯坦福大学/帕洛阿尔托退伍军人管理局(Keith Humphreys，MPI)添加到 协作。六个不同的卫生系统参加了WSN：1)OCHIN，2)Palo Alto VA和National 退伍军人医疗管理局，3)OHSU医疗系统，4)斯坦福医院和诊所，5) ProtoCall Services，Inc.，以及6)Health Share和Trillium Medicaid管理保健组织。无线传感器网络 测试新的干预措施，扩大阿片类药物使用障碍(Moud)的药物获得机会。 无线传感器网络的竞争性更新应用的首要目标是在 CTN填补了成瘾护理级联中的空白，从而改善了与之生活在一起的人的生活 药物使用障碍。我们通过对话制定了以成瘾护理为重点的研究议程 与不同的调查人员和利益相关者，包括吸毒者。两个研究主题 (药物试验和混合实施试验以弥补成瘾护理级联中的差距)提供了四个 可以帮助缩小治疗差距的CTN研究的例子。在研究主题1(药物试验)中， 药物试验1针对对目前可用的Moud不感兴趣的OUD患者 随机让他们接受长效口服氢吗啡酮与促进转介美沙酮或 丁丙诺啡改善治疗中的参与度和存留率。药物试验2为多部位试验3期 米氮平与安慰剂治疗甲基苯丙胺使用障碍的对比试验 冰毒的使用。在研究主题2(混合实施试验)中，两项试验将战略与 增强对Moud的参与度和留存度。混合有效性-实施试验1是一个集群- 电话+mHealth行为支持服务改善丁丙诺啡滞留的随机试验 初级保健。混合有效性-实施试验2测试远程实施同伴支持干预 与每周同伴监督相比，提高同伴在吸引和留住吸毒者方面的成功 治疗。我们在此研究议程中充斥着Node在VULNERABLE方面的基础设施和专业知识 人口、卫生系统、电子健康记录研究、数据科学和临床试验管理。 WSN将这些资源提供给CTN网络，以便在未来的CTN协议中使用。最后，无线传感器网络继续 利用CTN作为培训、传播和研究应用的平台。

Abstract The Western States Node's (WSN) research agenda for the National Drug Abuse Treatment Clinical Trials Network (CTN) competing renewal tests interventions to fill gaps in the Addiction Care Cascade, where progressively fewer people with drug use engage in treatment, receive pharmacotherapy, are retained in care, and experience sustained recovery. The Node proposes to continue the successful partnership between Oregon Health & Science University (OHSU; Todd Korthuis, MPI) and University of California San Francisco (UCSF; James Sorensen, Co-I), and adds Stanford University/Palo Alto VA (Keith Humphreys, MPI) to the collaboration. Six diverse health systems participate in WSN: 1) OCHIN, 2) The Palo Alto VA and national Veterans Healthcare Administration, 3) The OHSU health system, 4) Stanford Hospital and Clinics, 5) ProtoCall Services, Inc., and 6) Health Share and Trillium Medicaid managed care organizations. The WSN tests novel interventions that expand access to medications for opioid use disorder (MOUD). The overarching goal of the WSN's competing renewal application is to conduct collaborative research within the CTN that fills gaps in the Addiction Care Cascade and thereby enhances the lives of people living with drug use disorders. Our Addiction Care Cascade-focused research agenda developed through conversations with diverse investigators and stakeholders including people who use drugs. Two research themes (medication trials and hybrid implementation trials to close gaps in the Addiction Care Cascade) provide four examples of CTN studies that could help close treatment gaps. In Research Theme 1 (medication trials), Medication Trial 1 targets people with OUD who are not interested in currently available MOUD and randomizes them to receive long acting oral hydromorphone versus facilitated referral methadone or buprenorphine to improve engagement and retention in treatment. Medication Trial 2 is a multisite phase 3 trial of mirtazapine versus placebo for people with methamphetamine use disorder to reduce methamphetamine use. In Research Theme 2 (hybrid implementation trials), two trials compare strategies to enhance engagement and retention on MOUD. Hybrid Effectiveness-Implementation Trial 1 is a cluster- randomized trial of telephonic + mHealth behavioral support services to improve retention on buprenorphine in primary care. Hybrid Effectiveness-Implementation Trial 2 tests a telementoring peer support intervention versus weekly peer supervision to improve peer success in engaging and retaining people who use drugs in treatment. We suffuse this research agenda with the Node's infrastructure and expertise in vulnerable populations, health systems, electronic health records research, data science and clinical trials management. WSN offers these resources to the CTN network for use in future CTN protocols. Finally, WSN continues to use the CTN as a platform for training, dissemination, and research applications.