Predicting medical consequences of novel fentanyl analog overdose using the Toxicology Investigators Consortium (TOXIC)

使用毒理学研究联盟 (TOXIC) 预测新型芬太尼类似物过量的医疗后果

基本信息

批准号：
10160611
负责人：
Alex Francis Manini
金额：
$ 14.94万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-01 至 2025-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10160611
关键词：
2019-nCoV Accident and Emergency department Address Adult Adverse effects Affect Alcohol or Other Drugs use American Azithromycin Biological Assay COVID-19 COVID-19 pandemic Cardiovascular system Cessation of life Clinical Clinical Data Collaborations Commerce Critical Care Critical Illness Data Data Collection Databases Disease Outcome Drug Interactions Drug abuse Emergency Care Emergency Department patient Emergency department visit Enrollment Environmental Risk Factor Epidemiology Evaluation Event Failure Fentanyl Grant Health Heroin Home environment Homelessness Hospitals Hydroxychloroquine Immune Imprisonment Incidence Individual Infection Infrastructure Inpatients Institution Knowledge Laboratories Lung Marijuana Measures Mechanical ventilation Medical Medical Records Methadone Molecular Naloxone National Institute of Drug Abuse Opioid Outcome Overdose Patients Pharmaceutical Preparations Population Prevalence Principal Investigator Prospective cohort Public Health Registries Research Research Activity Research Personnel Resources Rest Risk Risk Factors Severities Substance Use Disorder Substance of Abuse Swab Time Toxicology United States Vent Ventilator Ventilatory Depression analog base clinical risk cohort cost data streams experience illicit opioid improved interest multidisciplinary novel opioid epidemic opioid overdose opioid use opioid use disorder opioid user overdose death pandemic disease patient registry population health prescription opioid prospective respiratory response social factors statistics stem synthetic opioid transmission process trend vaping

项目摘要

ABSTRACT AND PROJECT SUMMARY The purpose of this R01 proposal is to deepen our knowledge of the primary cause of drug overdose deaths in the U.S. today: novel psychoactive synthetic opioids, the majority of which are fentanyl analogues. Using a multicenter network, patients who present to emergency departments with novel fentanyl analogue overdose will be studied in terms of analytical confirmation, clinical risk factors, treatment needs, and regional trends. The PI has assembled a multidisciplinary team with an extensive track record of collaboration in the field. The scope of the U.S. opioid epidemic is broadening, with drug overdose deaths nearly tripling from 1999-2015. For the first time ever, in 2015 U.S. drug overdose deaths surpassed 50,000 (52,404), of which 33,091 (63.1%) involved an opioid. Overdose deaths continued to increase in 2016 to 63,600. Opioid overdoses cost Americans $504 billion in 2015 (2.8% of gross domestic product), up from six times the prior estimates in 2013. There was a 27% increase in nationwide Emergency Department visits for opioid overdoses last year alone. Strategies to mitigate this trend by decreasing the availability and abuse potential of prescription opioids have been followed by an increase in illicit opioid use. While initially the predominance of illicit opioid overdoses were a result of heroin exposure, the changing face of global drug commerce introduced synthetic opioid fentanyl analogues into the drug supply, where they are now estimated to have surpassed heroin as the primary cause of drug overdose deaths. Using nearly 70 hospital centers nationwide with bedside evaluation of patients, over 10,000 overdose patients have been enrolled in the Principal Investigator’s prior study giving this proposal momentum and feasibility. Our specific aims are three-fold: (1) To confirm and characterize fentanyl analogue overdoses in a new prospective cohort; (2) To evaluate sequelae, treatment needs, and resource utilization following fentanyl analogue overdoses; and (3) To trend and geolocate analytically confirmed fentanyl analogue overdoses across a multicenter network. To achieve these Specific Aims, we will prospectively enroll a new multicenter cohort of patients. We will implement the rapid dissemination of alerts and information to the public and public health entities on adverse effects of fentanyl analogues. At the completion of the proposed research, the field of drug abuse will be significantly advanced to allow prediction of medical consequences for thousands of victims of the U.S. opioid epidemic.

摘要和项目摘要该R01提案的目的是加深我们对药物过量死亡的主要原因的了解今天的美国：新型的精神活性合成OioIds，其中大多数是芬太尼类似物。使用多中心网络，以新颖的芬太尼类似物过量为出现在紧急部门的患者将根据分析确认，临床风险因素，治疗需求和区域趋势进行研究。 PI已经组建了一个多学科团队，并在该领域具有广泛的合作记录。美国阿片类流行的范围正在扩大，药物过量死亡几乎是三倍 1999-2015。 2015年，美国第一次过量药物过量死亡超过50,000（52,404） 33,091（63.1％）涉及阿片类药物。 2016年过量死亡人数继续增加到63,600。阿片类药物 2015年，过量服用的美国人（占国内生产总值的2.8％），高达六倍 2013年的估计。全国范围内的阿片类药物过量急诊室就诊增长了27％仅去年。通过降低的可用性和滥用潜力来减轻这种趋势的策略处方阿片类药物之后，非法阿片类药物使用量增加。虽然最初是非法阿片类药物过量是海洛因暴露的结果合成阿片类药物芬太尼类似物中的药物供应，现在估计它们已经超过海洛因是药物过量死亡的主要原因。在全国范围内使用近70个医院中心对患者进行床头评估，超过10,000次过量患者已入学首席研究员的事先研究，这给了这一提议势头和可行性。我们的具体目的是三倍：（1）确认和表征新的芬太尼类似物过量潜在队列；（2）评估芬太尼后后遗症，治疗需求和资源利用率类似物过量；（3）趋势和地理位置分析确认的芬太尼类似物过量跨多中心网络。为了实现这些特定目标，我们可能会招募新的多中心患者队列。我们将对公共和公共卫生实体的迅速传播警报和信息芬太尼类似物的不利影响。拟议研究完成时，药物滥用领域将要大大进步以允许对美国成千上万的受害者预测医疗后果 Oopioid流行病。