Massachusetts Justice Community Opioid Innovation Network (JCOIN) Clinical Research Center

马萨诸塞州司法社区阿片类药物创新网络 (JCOIN) 临床研究中心

• 批准号: 10385807
• 负责人: Elizabeth A. Evans
• 金额: $ 207.37万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10385807
• 关键词: Address; Adherence; Agonist; Ambulances; Caring; Cessation of life; Clinical Research; Collaborations; Collection; Communities; Community Services; County; Crime; Criminal Justice; Data; Data Set; Development; Emergency department visit; FDA approved; Foundations; Future; Goals; Health Personnel; Health Status; Healthcare; Imprisonment; Individual; Intervention Studies; Interview; Investigation; Jail; Justice; Laws; Link; Massachusetts; Medical; Mental Health Services; Methadone; Naltrexone; Opioid; Outcome; Outcome Measure; Outcome Study; Overdose; Overdose reduction; Participant; Pharmaceutical Preparations; Pilot Projects; Policies; Population; Principal Investigator; Prisons; Procedures; Public Health; Quality-Adjusted Life Years; Randomized; Records; Research; Scoring Method; Services; Suboxone; Substance Addiction; System; Testing; Time; Treatment outcome; Vital Statistics; antagonist; care coordination; comparative effectiveness trial; contextual factors; correctional system; cost; data warehouse; economic evaluation; effectiveness implementation study; experience; formative assessment; health related quality of life; health service use; high risk; implementation study; improved; innovation; insight; mortality; opioid epidemic; opioid overdose; opioid use; opioid use disorder; pilot trial; policy implication; prescription monitoring program; primary outcome; programs; rearrest; recidivism; reincarceration; secondary outcome; service utilization

A major driver of the U.S opioid crisis is limited access to effective medications for opioid use disorder (MOUD) that reduce overdose. Traditionally, jails and prisons in the U.S. do not initiate or maintain MOUD for inmates with OUD prior to their return to the community, which places them at high risk for fatal overdose. A 2018 law (“Chapter 208”) made Massachusetts (MA) the first state to mandate that five county jails deliver all FDA-approved MOUDs (extended-release naltrexone [XR-NTX] buprenorphine-naloxone [BUP-NX], and methadone). Chapter 208 establishes a 4-year pilot program to expand all FDA-approved forms of MOUD at five county jails; two more county jails in MA voluntarily joined this initiative. The law stipulates that MOUD be maintained in individuals receiving it prior to detention, and initiated prior to release among sentenced inmates where appropriate. The seven jails must also facilitate continuation of the medication in the community on release. The Massachusetts Justice Community Opioid Innovation Network proposes to partner with these seven diverse jails and community treatment providers to conduct a Type 1 hybrid effectiveness- implementation study of Chapter 208. We will: (1) Perform a longitudinal treatment outcome study among inmates with OUD who receive XR-NTX, BUP-NX, methadone, or no MOUD in jail utilizing MA’s powerful and innovative Public Health Data Warehouse, a collection of over two dozen linked state administrative data sets, to examine post-release MOUD initiation, engagement and retention, as well as fatal and non-fatal overdose and recidivism. Propensity score methods will adjust for selection effects. (2) Conduct an implementation study to understand contextual factors that facilitate and impede delivery of MOUDs in jail and community care coordination, and best practice strategies that optimize MOUD delivery in jail and coordinated care with community partners. (3) Perform a pilot randomized comparative effectiveness trial of antagonist (XR-NTX) versus agonist treatment (BUP-NX or methadone) initiated prior to release among 100 sentenced and follow- them 12-months post-release to examine outcomes that cannot be assessed in administrative data and determine procedures, acceptability, feasibility and effect sizes to support planning for a future randomized comparative effectiveness trial. (4) Calculate the cost to the correctional system of implementing MOUD in jail, and conduct an economic evaluation from state-policymaker and societal perspectives to compare the value of MOUD prior to release from jail to no MOUD among matched controls. The Mass JCOIN team, in collaboration with the MA Department of Public Health, seven MA county jails and community treatment partners, has the experience and expertise to fulfill the study aims. The Chapter 208 initiative has important implications for future policy and practice in the justice and OUD treatment systems at the local, state, and national levels. This study’s insights into Chapter 208’s implementation will inform the efficient development of future strategies to address OUDs in jail populations nationwide.

美国阿片类药物危机的主要驱动力是获得阿片类药物使用障碍有效药物的机会有限 （MOUD）减少过量用药。传统上，美国的监狱和监狱不会启动或维护穆德 与Oud返回社区之前，囚犯使他们面临致命过量的高风险。一个 2018年法律（“第208章”）使马萨诸塞州（马萨诸塞州）授权五个县监狱交付全部 FDA批准的MOUDS（扩展释放naltrexone [XR-NTX]丁丙诺啡 - 诺氧酮[BUP-NX]和 MEDAGADONE）。第208章建立了一项为期4年的试点计划，以扩展所有经FDA批准的MOUD的形式 五个县监狱； MA的另外两名县监狱自愿加入了这项倡议。法律定义了穆德 维持在被拘留前接受的个人，并在被判刑之前释放之前启动 在适当的地方。七个监狱还必须促进社区中的药物延续 发布。马萨诸塞州正义社区阿片类药物创新网络提案，以与这些网络合作 七个潜水员监狱和社区治疗提供者进行1型混合有效性 - 第208章的实施研究。我们将：（1）在 使用MA强大的和 创新的公共卫生数据仓库，二十多个链接的州行政数据集的集合， 检查释放后的MOUD启动，参与和保留，以及致命的和非致命的过量 和累犯。倾向分数方法将调整选择效果。 （2）进行实施研究 了解有助于促进和妨碍在监狱和社区护理中交付穆德的情境因素 协调和最佳实践策略，以优化在监狱中交付并与之协调的护理 社区合作伙伴。 （3）进行拮抗剂（XR-NTX）的飞行员随机比较有效性试验 在释放100份判决和后续释放之前，与激动剂治疗（BUP-NX或MEADADONE） 他们有12个月的释放后，以检查无法在行政数据中评估的结果 确定程序，可接受性，可行性和效果大小，以支持未来随机的计划 比较有效性试验。 （4）计算在监狱中实施穆德的纠正措施的成本， 并从国家 - 充电制造者和社会观点进行经济评估，以比较 在匹配的控件中，在从监狱中释放到没有穆德之前的穆德。 大众JCOIN团队与MA公共卫生部合作，七个硕士县监狱 社区治疗伙伴有实现研究目的的经验和专业知识。第208章 倡议对正义和OUD治疗系统的未来政策和实践具有重要意义 地方，州和国家一级。这项研究对第208章实施的见解将告知 有效地制定未来在全国监狱人口中解决Ouds的策略。