Heroin Price, Purity and Outcomes Study

海洛因价格、纯度和结果研究

基本信息

批准号：
8633026
负责人：
DANIEL H CICCARONE
金额：
$ 35.73万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-03-15 至 2016-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8633026
关键词：
Abscess Affect Area Bacterial Infections Behavior Behavioral Belief System Blood Cellulitis Cities Clostridium Infections Confounding Factors (Epidemiology)Consumption Data Databases Disease Economics Endocarditis Environment Epidemic Epidemiologic Studies Ethnography Etiology Foundations HIV Health Hepatitis C Heroin Heroin Users Hygiene Infection Injecting drug user Injury Intervention Interview Knowledge Lead Logic Marketing Medical Methods Modeling Morbidity - disease rate Morphology Necrotizing fasciitis Outcome Outcome Study Overdose Pattern Pharmaceutical Preparations Population Surveillance Powder dose form Prevalence Price Public Health Research Research Project Grants Risk Risk Behaviors Social Environment Soft Tissue Infections Source Tars Techniques Time United States War disorder prevention experience improved methicillin resistant Staphylococcus aureus metropolitan overdose death preference prevent public health relevance regional difference social soft tissue theories trend

项目摘要

DESCRIPTION (provided by applicant): Public health efforts in preventing HIV and related diseases with injection drug users require clear understandings of the risk environment of drug consumption. One important aspect of the risk environment is drug supply. Specifically, the supply of heroin into the United States is changing dramatically: Over the past twenty years, heroin prices have decreased nationwide to record levels as purity has increased. This has occurred during the same time period as the number of heroin source regions has been reduced from 4 to 2. Heroin use is associated with significant social and medical problems. HIV and other blood-borne infections, e.g., hepatitis C, are still major concerns, but there is also rising concern about non-HIV heroin related medical consequences, e.g., heroin related overdose (HOD), soft tissue and other bacterial infections (BSTI), including abscess, cellulitis, necrotizing fasciitis and various clostridial infections, and endocarditis. The two US sources of heroin produce chemically distinct forms which maybe perceived/used differently. The two major heroin morphologies, "Black tar" heroin (BTH) and powdered heroin (PH) have preliminary associations with specific diseases. BTH is suggestively associated with soft tissue infections, while PH is ecologically correlated with HIV. These two forms have distinct geographic markets with BTH predominating in the western US and PH in the eastern US. Notably, preliminary research has shown significant ecological correlation between HIV prevalence among heroin injectors in western and eastern US cities and regional differences in the distribution of BTH and PH. Very little research has been done that analyzes the distinctive health problems associated with the different types of heroin and relates these differences to patterns of use. The purpose of this study is to illuminate the medical consequences particular to the two major types of heroin commonly found in the United States and relate them to changes in availability, price, purity and differing use patterns for these drugs. The specific objectives of this research project are: 1. To examine the trends in heroin related medical outcomes, e.g., HOD, BSTI, in up to 29 US metropolitan areas (MSAs), between 1990-2006, by changes in local heroin price and purity. 2. To examine the associations between the distribution of specific types of heroin (i.e., BTH and PH) and heroin related outcomes, e.g., HIV, HOD, and BSTI, in 20 US MSAs, controlling for confounding variables. 3. To assess the behaviors and belief systems of heroin users related to their use of specific types of heroin, in two cities; each with an exemplar heroin type. The Heroin Price, Purity and Outcomes (HPPO) study proposes a mixed methods approach. Specific Aims 1 and 2 will be achieved by combining governmental databases on heroin economic data with multiple national databases on medical outcomes, analyzed using advanced statistical techniques. Specific Aim 3 will involve two forms of qualitative inquiry: ethnographic assessment and in-depth qualitative interviews.

描述（由申请人提供）：预防注射吸毒者艾滋病毒和相关疾病的公共卫生工作需要清楚地了解吸毒的风险环境。风险环境的一个重要方面是毒品供应。具体来说，美国的海洛因供应正在发生巨大变化：过去二十年来，随着纯度的提高，全国范围内的海洛因价格已下降至创纪录水平。这一情况发生在海洛因来源地区数量从 4 个减少到 2 个的同一时期。海洛因的使用与严重的社会和医疗问题有关。 HIV 和其他血源性感染（例如丙型肝炎）仍然是主要问题，但人们也越来越担心非 HIV 海洛因相关的医疗后果，例如海洛因相关过量 (HOD)、软组织和其他细菌感染 (BSTI) ），包括脓肿、蜂窝组织炎、坏死性筋膜炎和各种梭菌感染以及心内膜炎。美国的两种海洛因来源产生的化学形式不同，其感知/使用可能有所不同。两种主要的海洛因形态，“黑焦油”海洛因 (BTH) 和粉状海洛因 (PH) 初步与特定疾病相关。 BTH 与软组织感染相关，而 PH 在生态上与 HIV 相关。这两种形式具有不同的地域市场，BTH 在美国西部占主导地位，PH 在美国东部占主导地位。值得注意的是，初步研究表明，美国西部和东部城市海洛因注射者的艾滋病毒感染率与 BTH 和 PH 分布的区域差异之间存在显着的生态相关性。很少有研究分析与不同类型海洛因相关的独特健康问题并将这些差异与使用模式联系起来。本研究的目的是阐明美国常见的两种主要类型海洛因的特定医学后果，并将其与这些药物的可用性、价格、纯度和不同使用模式的变化联系起来。该研究项目的具体目标是： 1. 通过当地海洛因价格的变化和 1990 年至 2006 年期间美国多达 29 个大都市区 (MSA) 的海洛因相关医疗结果（例如 HOD、BSTI）的趋势。纯度。 2. 研究 20 个美国 MSA 中特定类型海洛因（即 BTH 和 PH）的分布与海洛因相关结果（例如 HIV、HOD 和 BSTI）之间的关联，并控制混杂变量。 3. 评估两个城市海洛因使用者与使用特定类型海洛因相关的行为和信仰体系；每个都有一个典型的海洛因类型。海洛因价格、纯度和结果 (HPPO) 研究提出了一种混合方法。具体目标 1 和 2 将通过将政府海洛因经济数据数据库与多个国家医疗结果数据库相结合并使用先进统计技术进行分析来实现。具体目标 3 将涉及两种形式的定性调查：人种学评估和深入定性访谈。