Multilevel SUD and Overdose Prevention for Rural Youth Involved in County Legal Systems

PROJECT SUMMARY
Youth involved in the legal system (YILS) have extremely high rates of substance and opioid use disorders
(SUD/OUD) and do not have access to the resources to prevent serious use sequelae. SUD prevention and
overdose prevention (harm reduction) interventions are critically important to delay escalation to synthetic
opioids and prevent fatalities and health/legal consequences. Washington State is facing an overdose crisis;
overdose deaths increased by 40% in a year, a steeper increase than any other state. Rural counties in this
state report overdose rates that are as high or higher than urban ones. Thus, rural YILS are particularly
vulnerable to overdose and lack adequate prevention services. Optimal SUD/OUD and overdose prevention
for rural YILS requires a multifaceted approach, which our experienced team is ideally poised to develop,
implement, and test. We have developed a successful hybrid remote-in person model in a previous grant
working with the state juvenile incarceration system that is ideally suited to serving rural county court-involved
YILS. We have strong support for this collaborative application from rural county court systems, who are
motivated to intervene with YILS earlier in the spectrum of legal system and substance use involvement.
Overall, the goal of the 2-year R61 phase will be to codesign a multilevel SUD/overdose strategy to prevent
escalation to OUD/overdose among YILS in rural county juvenile court systems, and the tools needed to
reliably implement this strategy. Specifically, we will collaboratively codesign components of a multilevel
SUD/overdose prevention strategy with a multisector group representing state and local governments,
service sector leaders, and consumer parents/YILS (R61 Aim 1). We will also codesign a reproducible
implementation plan for the multilevel intervention developed in Aim 1 that can be reliably implemented in
rural courts (R61 Aim 2). The overall goal of the 3-year R33 phase will be to test our codesigned strategy on
implementation and effectiveness outcomes. We will do this by conducting a hybrid type 2 stepped wedge
trial with 15 counties, surveying 470 youth (for an anticipated 360 complete cases) and tracking county
implementation metrics every three months to understand effects of multilevel intervention including
prevention education and harm reduction to reduce the harms attributable to active drug use. Outcomes will
include implementation (reach and adoption; R33 Aim 1) and effectiveness (overdose and naloxone
knowledge; frequency of use of overdose-associated and other substances; R33 Aim 2). This proposal is
innovative, high impact, and highly responsive to RFA-24-036. With our substance use prevention experience
and existing relationships with juvenile legal systems, we are uniquely positioned to be successful in
engaging diverse perspectives with rural legal systems to codesign and test a multilevel substance and
overdose prevention trial. The intervention and implementation processes we develop will be immediately
reproducible in other rural jurisdictions to address the needs of some of the highest risk youth in the country.

Grant Number: 1R61DA061846-01
NIH Institute/Center: NIH
Principal Investigator: KYM AHRENS