Study design to evaluate a group-based therapy for support persons of adults on buprenorphine/naloxone.

BACKGROUND: Opioid use disorders (OUDs) have devastating effects on individuals, families, and communities. While medication treatments for OUD save lives and are increasingly utilized, rates of treatment dropout are very high. In addition, most existing medication treatments for OUD may often neglect the impact of untreated OUD on relationships and ignore the potential role support persons (SPs) could have on encouraging long-term recovery, which can also impact patient treatment retention. METHODS/DESIGN: The current study adapts Community Reinforcement and Family Training (CRAFT) for use with SPs (family member, spouse or friend) of patients using buprenorphine/naloxone (buprenorphine) in an outpatient community clinic setting. The study will evaluate whether the adapted intervention, also known as integrating support persons into recovery (INSPIRE), is effective in increasing patient retention on buprenorphine when compared to usual care. We will utilize a two-group randomized design where patients starting or restarting buprenorphine will be screened for support person status and recruited with their support person if eligible. Support persons will be randomly assigned to the INSPIRE intervention, which will consist of 10 rolling group sessions led by two facilitators. Patients and SPs will each be assessed at baseline, 3 months post-baseline, and 12 months post-baseline. Patient electronic medical record data will be collected at six and 12 months post-baseline. We will examine mechanisms of intervention effectiveness and also conduct pre/post-implementation surveys with clinic staff to assess issues that would affect sustainability. DISCUSSION: Incorporating the patient's support system may be an important way to improve treatment retention in medication treatments for OUD. If SPs can serve to support patient retention, this study would significantly advance work to help support the delivery of effective treatments that prevent the devastating consequences associated with OUD. Trial registration This study was registered with ClinicalTrials.gov, NCT04239235. Registered 27 January 2020, https://clinicaltrials.gov/ct2/show/NCT04239235 .

Costs and Effectiveness of Interventions to Reduce Motor Vehicle-Related Injuries and Deaths: Supplement to Tool Documentation.

Motor vehicle crashes account for a large number of deaths and injuries. In the United States, in 2015, more than 35,000 people were killed and approximately 2.44 million were injured in motor vehicle crashes. In 2010, the economic costs associated with motor vehicle crashes in the United States were substantial, estimated to be $242 billion. Fortunately, a wide range of evidence-based interventions, including both policies and programs, can help prevent motor vehicle-related injuries and deaths. In 2014, RAND researchers developed an online tool, the Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS), to help determine the costs and effectiveness of various interventions to reduce injuries and deaths from motor vehicle crashes and what interventions together generate the largest reductions in injuries and deaths for a given implementation budget. A 2015 update added two new interventions and produced a series of reports about allocating traffic safety funds. The 2017 update, MV PICCS 3.0, determined whether to add new interventions, updated information on the interventions' effectiveness and costs, and redesigned the tool's user interface to be more user-friendly.

The Road to Zero: A Vision for Achieving Zero Roadway Deaths by 2050.

Imagine that, in 2050, not a single person in the United States dies in a traffic crash. This is the scenario described in this article, in which RAND researchers set forth a vision and strategy for achieving zero roadway deaths by 2050. The authors propose that a combination of three approaches can realize this scenario. The first is doubling down on programs and policies that have already been shown to be effective, including laws and enforcement, changes to roadway infrastructure designed to reduce traffic conflicts, reductions in speeds where crashes are likely, improvements to emergency response and trauma care, and more safety education and outreach. The second is accelerating advanced technology, beginning with advanced driver assistance systems (many of which are already in the market) and progressing up to fully automated vehicles. The third is prioritizing safety, which includes both (1) embracing a new safety culture that will lead Americans to think differently about our individual and collective choices and (2) widespread adoption of the "Safe System" approach, a paradigm shift in addressing the causes and prevention of roadway deaths and injuries. The authors conclude with a list of actions that key stakeholders-including professional engineering and planning organizations, public-sector organizations, safety advocates, vehicle manufacturers, technology developers, public health, emergency medical and trauma care organizations, and law enforcement and judicial system representatives-can take to bring about the changes needed to achieve zero roadway deaths by 2050.

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans.

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans' demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth.

Understanding and Reducing Off-Duty Vehicle Crashes Among Military Personnel.

The authors review traffic safety in the United States, with specific reference to military personnel, focusing on safety interventions and attempts to change driver behavior and decisions. Overall, driving has become safer over the last 20 years: A variety of factors seem to have contributed to this increased safety-better vehicle safety features, better road safety features, decreases in teenage drunk driving, more seat belt use, and at least recently, fewer vehicle miles traveled. In contrast, motorcycle riding, a topic of particular interest to the military, is becoming more dangerous. The main difference between the military and civilian population is the proportion of military crash fatalities on motorcycles-the U.S. rate is currently about 15 percent of fatalities, while in some military branches the rate is on average 35-40 percent. This review shows that the following safety interventions tend to help in the reduction of vehicle crashes and that some in particular may be useful in the military setting: (1) better enforcement of underage drinking laws and continuation of alcohol deglamorization campaigns (Department of Defense regulations exist, but underage drinking seems to be relatively common); (2) high-visibility enforcement techniques for sobriety checkpoints; (3) high-visibility enforcement techniques for seat belt use; (4) adoption of a lower blood alcohol concentration level (such as 0.05) for motorcyclists, since the evidence shows that motorcyclists' ability to drive safely begins declining at lower levels than those for car drivers; (5) screening-perhaps as part of military medical assessment-and brief intervention with a trained counselor for at-risk drinkers, since they are at higher risk for drinking and driving; (6) media campaigns that are paired with community activities that also emphasize driver safety, such as workshops or fairs and with enforcement of driving regulations, and targeted at the drivers at highest risk (men in their teens and early 20s); (7) requirements that motorcyclists be licensed and own their vehicles.