Peer Engagement in Methamphetamine Harm-Reduction with Contingency Management (PEER-CM)

项目摘要/摘要 芬太尼和甲基苯丙胺(MA)的使用使2021年成为美国吸毒者死亡人数最多的一年 美国(美国)。故意将MA与芬太尼联合使用以及不断增加的掺假会增加风险和 与使用MA相关的危害--涉及精神刺激剂的药物过量死亡的年龄调整比率 (主要是并购)在2009至2019年间增长了10倍。人们对预防过量服药知之甚少，包括 MA或让使用MA的人参与减少和治疗危害。吸引使用移动支付的人员的策略 在减少危害方面，活动至关重要。应急管理(CM)使用奖励来激励 这是改善治疗中的保留率和减少兴奋剂使用的最有效策略。 同伴康复支持专家帮助没有寻求治疗的人确定减少伤害的方式 目标和参与治疗。PEER-CM研究结合了循证干预-CM和 同伴参与--减少服药过量，提高对以下人群的减害服务参与度 使用MA。我们的同龄人减少伤害组织网络渴望为以下目标确定最佳策略 执行俄勒冈州最近批准的可持续CM资金，以减少过量用药。Peer-CM研究 测试激励实现自我确定的减少人身伤害目标的效果与 照顾标准(减少同伴伤害服务，鼓励同伴探访)，以扩大覆盖范围和 减少有害物质危害服务的有效性。一种混合类型1效力实施框架和 阶梯式楔形设计随机选择了18个基于社区的同伴减少伤害站点，以提供标准 关爱(对同伴接触的激励)与客户实现自我识别、减少人身伤害的对比 目标。同龄人使用客户驱动的减少伤害目标来帮助客户设置个人减少伤害目标- 设置流程重点是完成减害用品培训，拥有减害用品， 日常生活目标，治疗和护理目标，以及关系和社会支持目标。CM干预是 在阶梯式楔形设计中每隔三个月推出一次(一次两个同行站点)。同行管理 鼓励和促进在实现自我确定的目标方面取得进展。目标1测试激励措施的影响 在使用MA的人群中实现自我确认的、减少人身伤害的目标，以降低过量用药的可能性。 目标2确定实现自我确定的减少人身伤害目标的激励措施是否增加 参与减少伤害和治疗服务。目标3完成定性访谈以了解 同行协助的应急管理的最佳背景和实施战略。同龄人- CM研究提出了以患者为中心、可持续、可扩展和创新的应急管理模式 增加在传统治疗网络之外提供的减少危害的影响，遏制这股浪潮 在使用MA的人中使用过量的药物。与俄勒冈州卫生局的同龄人倡议合作 促进政策变化和可持续服务远远超出拟议工作的范围。

Project Summary/Abstract Use of fentanyl and methamphetamine (MA) made 2021 the deadliest year ever for people using drugs in the United States (US). Intentional co-use as well as rising adulteration of MA with fentanyl elevate the risks and harms associated with MA use – the age-adjusted rate of drug overdose deaths involving psychostimulants (primarily MA) increased 10-fold between 2009 and 2019. Little is known about preventing overdoses involving MA or engaging people using MA in harm reduction and treatment. Strategies to engage people who use MA in harm reduction activities are essential. Contingency management (CM) uses rewards to incentivize behaviors and is the most efficacious strategy for improved retention in treatment and reduced stimulant use. Peer recovery support specialists reach people not seeking treatment to help them identify harm reduction goals and engage in treatment. The PEER-CM study combines both evidence-based interventions—CM and peer engagement--to decrease overdose and improve engagement in harm reduction services for people who use MA. Our network of peer harm reduction organizations is eager to identify optimal strategies for implementing Oregon’s recent approval of sustainable CM funding to reduce overdose. The PEER-CM study tests the effect of incentivizing achievement of self-identified, personal harm reduction goals compared with standard of care (peer harm reduction service with incentives for peer visits) to increase the reach and effectiveness of MA harm reduction services. A hybrid type 1 effectiveness-implementation framework and stepped-wedge design randomizes eighteen community-based peer harm reduction sites to provide standard of care (incentives for peer encounters) versus client achievement of self-identified, personal harm reduction goals. Peers assist clients in setting personal harm reduction goals using a client-driven harm reduction goal- setting process focused on completing harm reduction supply training, possessing harm reduction supplies, daily life goals, treatment and care goals, and relationship and social support goals. The CM intervention is rolled out at three-month intervals in the stepped-wedge design (2 peer sites at a time). Peers manage incentives and facilitate progress towards meeting self-identified goals. Aim 1 tests the impact of incentives for achieving self-identified, personal harm reduction goals on the likelihood of overdose among people using MA. Aim 2 determines whether incentives for achieving self-identified, personal harm reduction goals increase engagement with harm reduction and treatment services. Aim 3 completes qualitative interviews to understand the optimal context and implementation strategies for peer-facilitated contingency management. The PEER- CM study advances a patient-centered, sustainable, scalable, and innovative contingency management model to increase the impact of harm reduction delivered outside of traditional treatment networks and stem the tide of overdose among people who use MA. The collaboration with the Oregon Health Authority’s peer initiative facilitates policy change and sustainable services well beyond the proposed work.