Using SMART Design to Identify an Effective and Cost-Beneficial Approach to Preventing OUD in Justice-Involved Youth

使用 SMART 设计确定有效且具有成本效益的方法，以防止参与司法的青少年出现 OUD

• 批准号: 10831796
• 负责人: KYM R AHRENS
• 金额: $ 37.36万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 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/10831796
• 关键词: Abstinence; Address; Administrator; Adolescent; Area; Behavioral; Black race; Child; Child Welfare; Data; Data Linkages; Data Sources; Development; Disease; Education; Ensure; Event; Exposure to; Family; Fentanyl; Frequencies; Future; General Population; Goals; Harm Reduction; Health Personnel; Helping to End Addiction Long-term; Imprisonment; Individual; Information Systems; Intervention; Interview; Justice; Legal system; Link; Measures; Medical; Methods; Motivation; Naloxone; National Institute of Drug Abuse; Nurses; Opioid; Overdose; Overdose reduction; Persons; Pharmaceutical Preparations; Policies; Policy Maker; Population; Preparation; Prevention strategy; Procedures; Provider; Public Health; Qualifying; Randomized, Controlled Trials; Recording of previous events; Rehabilitation therapy; Relapse; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Risk Reduction; Running; Strategic Planning; Structure; Substance Use Disorder; System; Techniques; Testing; Text Messaging; United States Substance Abuse and Mental Health Services Administration; Vulnerable Populations; Washington; Youth; brief prevention intervention; cost; design; experience; fentanyl test; high risk population; intervention refinement; modifiable risk; motivational enhancement therapy; opioid overdose; opioid use; opioid use disorder; overdose death; overdose prevention; overdose risk; parole; polysubstance use; prevent; preventive intervention; response; screening; substance misuse; substance use; synthetic opioid; test strip; therapy design; trend; young adult

SUMMARY/ABSTRACT Youth involved in legal systems (YILS) are a vulnerable population with high rates of substance use and overdose. Due to forced abstinence and consequent lower tolerance rates, the risk of overdose is 50 times higher for incarcerated persons than the general population in the first two weeks after release. Nationally, commensurate with the rise in frequency of illicitly produced fentanyl and other synthetic opioids, adolescent overdose risk is increasing dramatically. Risk factors are also changing. Previously, prior use of highly potent opioids and opioid or polysubstance use disorder were critical risk factors for adolescent/young adult overdose. Currently only one in three youth that fatally overdoses has used opioids previously. In the Washington State Department of Children, Youth, and Families Juvenile Rehabilitation (DCYF JR) system almost 1 in 3 youth in our state-run facilities qualify as having opioid use disorder, and 58% of youth screened for substance use disorders indicate that they have overdosed non-fatally at some point in the past. We seek to conduct a mixed methods study to triangulate identification of modifiable overdose risk factors for YILS, develop strategies to measure this risk, and develop and test a multilevel intervention to reduce this risk. We anticipate that a combination of education, proven harm reduction strategies, and strategies to increase behavioral motivation will be the most effective way to reduce overdose risk amongst incarcerated youth. Although this proposal is focused on a specific high-risk population (incarcerated youth), we will develop overdose prevention strategies that can be replicated in other populations, addressing one of our nation's most critical public health concerns. In Aim 1 we will conduct qualitative individual semi-structured interviews with youth with exposure to overdose (20-30); internal stakeholders such as staff and medical personnel (10-15); and external stakeholders with research or policy expertise (5-10). In Aim 2 we will conduct a cross-sectional assessment of administrative DCYF JR data to identify modifiable risk reduction factors associated with prior overdose event. In Aim 3 we will develop multilevel preventive intervention data from prior aims. We anticipate including educational campaigns/initiatives, naloxone and fentanyl test strip distribution, motivational interviewing to develop overdose prevention goals and enhance motivation to carry out these goals, and text messaging reminder components. We will test specific components of the intervention in need of refinement with 20 DCYF JR youth, in anticipation of a future randomized controlled trial (RCT). Finally, we will explore data linkages between DCYF JR and other administrative data systems to determine if it is possible to predict which system(s) youth experiencing fatal or near fatal overdose are most likely to have interacted with in the 2 months prior to the overdose event. This proposal is aligned with NIDA's HEAL initiative and strategic plan and will reduce overdose risk among our nation's most vulnerable youth.

摘要/摘要 参与法律系统的青少年 (YILS) 是弱势群体，吸毒率很高，并且 过量。由于强制戒酒和随之而来的较低耐受率，过量服用的风险是原来的50倍 被监禁者在释放后的前两周内的比例高于普通人群。在全国范围内， 随着非法生产芬太尼和其他合成阿片类药物频率的增加，青少年 服用过量的风险正在急剧增加。风险因素也在发生变化。以前，事先使用过高效能的 阿片类药物和阿片类药物或多物质使用障碍是青少年/年轻人用药过量的关键危险因素。 目前，只有三分之一因过量服用阿片类药物而致命的青少年以前曾使用过阿片类药物。在华盛顿州 儿童、青少年和家庭部青少年康复 (DCYF JR) 系统几乎三分之一的青少年 我们的国营设施符合阿片类药物使用障碍的资格，58% 的青少年接受了药物滥用筛查 疾病表明他们在过去的某个时刻服用过过量药物，但未造成致命。我们寻求进行混合 方法研究三角测量可改变的YILS过量危险因素的识别，制定策略 衡量这种风险，并开发和测试多层次干预措施以降低这种风险。我们预计， 结合教育、行之有效的减少伤害策略和增加行为动机的策略 将是减少被监禁青少年服药过量风险的最有效方法。虽然这个提议是 针对特定的高危人群（被监禁的青少年），我们将制定过量预防策略 这可以在其他人群中复制，解决我们国家最关键的公共卫生问题之一。 在目标 1 中，我们将对吸毒过量的青少年进行定性个人半结构化访谈 （20-30）；内部利益相关者，例如工作人员和医务人员（10-15）；和外部利益相关者 研究或政策专业知识（5-10）。在目标 2 中，我们将对行政管理进行横断面评估 DCYF JR 数据用于识别与既往用药过量事件相关的可修改风险降低因素。在目标 3 中，我们 将根据先前的目标开发多层次的预防干预数据。我们预计包括教育 活动/倡议、纳洛酮和芬太尼试纸分发、动机访谈以制定 预防过量用药目标并增强执行这些目标的动力，并短信提醒 成分。我们将使用 20 DCYF JR 测试需要改进的干预措施的具体组成部分 年轻人，期待未来的随机对照试验（RCT）。最后，我们将探讨数据链接 DCYF JR 和其他行政数据系统之间的数据分析，以确定是否可以预测哪些 经历过致命或近乎致命的药物过量的青少年最有可能在以下 2 种情况中发生过互动 服药过量事件前几个月。该提案与 NIDA 的 HEAL 倡议和战略计划相一致， 将减少我国最弱势青少年的用药过量风险。