Optimized Interventions to Prevent Opioid Use Disorder among Adolescents and Young Adults in the Emergency Department

预防急诊科青少年和年轻人阿片类药物使用障碍的优化干预措施

• 批准号: 10212539
• 负责人: Erin E. Bonar
• 金额: $ 517.17万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10212539
• 关键词: Accident and Emergency department; Achievement; Adolescent and Young Adult; Adult; Age; Alcohol or Other Drugs use; Alcohols; Cannabis; Childhood; Clinical; Computer software; Computerized Medical Record; Data; Development; Drug usage; Emergency department screening; Emergency department visit; Evaluation; Fentanyl; Formulation; Health; Health Care Visit; Healthcare Systems; Heroin; Heterogeneity; Injections; Intention; Intervention; Life; Maintenance; Mediator of activation protein; Medicine; Mental Health; Morbidity - disease rate; Motivation; National Institute of Drug Abuse; Online Systems; Opioid; Oral; Outcome; Outcome Measure; Overdose; Pain interference; Pamphlets; Phase; Prevention; Prevention strategy; Primary Health Care; Public Health; Randomized; Randomized Controlled Trials; Research; Resources; Risk; Risk Behaviors; Risk Factors; Route; Self Efficacy; Services; Severities; Source; Structure; Surveys; Technology; Telemedicine; Testing; Therapeutic; Time; Treatment Efficacy; Work; base; brief alcohol intervention; brief intervention; cost; cost effective; economic evaluation; efficacy testing; experience; health care settings; health data; health service use; illicit opioid; impaired driving performance; innovation; misuse of prescription only drugs; mobile application; mortality; motivational enhancement therapy; opioid epidemic; opioid misuse; opioid overdose; opioid use; opioid use disorder; overdose risk; patient portal; pill; prescription monitoring program; prescription opioid; prevent; primary outcome; reduced substance use; risk perception; secondary analysis; sex; substance misuse; treatment as usual; trial design; web portal; young adult

Project Summary Opioid use by older adolescents and young adults (AYAs; ages 16-30) is a significant public health concern requiring scalable approaches to prevent opioid misuse and opioid use disorders (OUDs). A unique feature of the opioid crisis is the rapidly morphing clinical sequela, which includes changes in opioids used based on evolving access to prescription medicines (e.g., due to rescheduling, prescription drug monitoring programs), availability of street opioids and new formulations (e.g., illicitly made fentanyl), and varying routes of administration associated with escalation in use (e.g., oral, snorting, injection). A health care visit provides an access point to identify and intervene with AYAs at risk for opioid misuse/OUD to alter risk trajectories. The emergency department (ED) is an ideal venue to reach AYAs, particularly as young adults may disconnect from primary care when transitioning out of pediatric medicine. The ED is also common source of opioid prescriptions. Despite promising findings from our prior work on efficacious ED brief interventions (BIs) that reduced opioid misuse/overdose risk, and other substance use (secondary analyses of our alcohol BI reduced prescription drug misuse), modest effect sizes limit the public health impact of one-session BIs. Further, we lack critical data on how to extend interventions for maximal impact, with parsimony of resources and ease of implementation in healthcare settings. The proposed study will evaluate the efficacy of interventions of varying type/intensity, tested using a four group randomized controlled trial design. The proposed work leverages technology that is appealing to AYAs to facilitate intervention delivery by health coaches (HCs), promoting fidelity along with real-time tailoring in accordance with the rapidly changing opioid landscape. The specific aims are to: 1) adapt promising HC-delivered interventions and pilot test feasibility/acceptability in AYAs (UG3); 2) evaluate the efficacy of interventions and their combinations on preventing/reducing opioid misuse and OUD among AYAs (UH3); and 3) examine ED implementation and sustainability, including economic evaluation (UH3). Secondary aims are to examine efficacy on other substance use, and moderators (e.g., sex, motives, opioid risk severity) and mediators (e.g., self-efficacy, motivation to change) of outcome. AYAs (ages 16-30; N=1170) in the ED screening positive for opioid use (+ ≥1 risk factor) or misuse will be stratified by risk severity and sex and randomly assigned to one of two ED-based conditions [(Check-In BI delivered by HC via remote video chat, or enhanced usual care brochure (EUC)], with or without HC messaging via web portal (Check-In Portal for 4 weeks). Thus, the four conditions are: EUC only, BI only, Portal Only, BI + Portal, with outcomes measured at 4-, 8-, and 12-months. This study is innovative by testing the efficacy of interventions to prevent/reduce opioid misuse/OUD, which are feasible to implementation in healthcare systems. Technology- driven, scalable interventions via HC delivery allow for real-time tailoring to the rapidly changing opioid epidemic, which could have high, sustainable impact on preventing escalation of opioid misuse among AYAs.

项目摘要 老年青少年和年轻人的阿片类药物使用（AYAS； 16-30岁）是一个重大的公共卫生问题 需要可扩展的方法来防止阿片类药物滥用和阿片类药物使用障碍（OUDS）。一个独特的功能 阿片类药物危机是快速变形的临床后遗症，其中包括基于阿片类药物的变化 不断获得处方药的机会（例如，由于重新安排，处方药监测计划）， 街道阿片类药物和新配方的可用性（例如，非法制作的芬太尼），以及不同的路线 与使用中升级有关的给药（例如，口服，鼻子，注射）。医疗访问提供了 访问点识别和干预AYA有风险的阿片类药物MISSUSE/OUD改变风险轨迹。这 紧急部门（ED）是到达AYA的理想场所，尤其是年轻人可能断开连接 从小儿医学过渡时从初级保健。 ED也是阿片类药物的常见来源 处方。尽管我们先前在有效的ED简短干预措施（BIS）的工作中有希望的发现， 降低阿片类药物的小姐/过量风险和其他药物使用（对酒精BI的次要分析减少了 处方药滥用），适度的效果尺寸限制了一项课程bis的公共卫生影响。此外，我们 缺乏有关如何扩展干预措施以获得最大影响的关键数据 在医疗机构中实施。拟议的研究将评估不同的干预效率 类型/强度，使用四组随机对照试验设计进行测试。拟议的工作利用 吸引AYA的技术促进健康教练（HCS）的干预，促进 根据迅速变化的阿片类药物景观，忠实的量身定制。具体 目的是：1）适应有希望的HC提供的干预措施，并在AYAS中适应可行性/可接受性（UG3）； 2）评估干预措施的效率及其在防止/减少阿片类药物和OUD方面的组合 在ayas中（UH3）； 3）检查实施和可持续性，包括经济评估 （UH3）。次要目的是检查对其他物质使用和主持人的有效性（例如，性，动机， 卵风险的严重程度）和介体（例如自我效能，改变动机）的结果。 ayas（16-30岁； n = 1170）在ED筛查中使用阿片类药物阳性（+≥1风险因素）或小姐将按风险严重程度进行分层 和性别，并随机分配给两个基于ED的条件之一（（HC通过遥控器提供的签名BI 视频聊天或增强的常规护理手册（EUC）]，通过Web Portal有或没有HC消息传递（签到 门户4周）。这四个条件是：仅EUC，仅BI，仅门户，BI +门户，带有结果 在4-，8-和12个月下测量。这项研究是通过测试干预效率的创新性 防止/减少oid missuse/oud，这对于在医疗保健系统中实施是可行的。技术- 通过HC交付的驱动，可扩展的干预措施允许实时裁缝以快速变化的Ooid 流行病可能会对防止AYAS中阿片类药物的升级升级产生较高的可持续影响。