An ethno-epidemiological study of the implementation and effectiveness of an innovative and comprehensive response to the opioid epidemic

针对阿片类药物流行病的创新和综合应对措施的实施和有效性的民族流行病学研究

• 批准号: 9910376
• 负责人: Thomas Kerr
• 金额: $ 34.24万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9910376
• 关键词: AIDS/HIV problem; Acute; Address; Adult; American Medical Association; Automobile Driving; Behavioral; British Columbia; Canada; Caring; Cessation of life; Characteristics; Clinical; Clinical Practice Guideline; Clinical Research; Clinics and Hospitals; Cohort Studies; Communities; Community Health; Complement; Complex; Congresses; Continuity of Patient Care; Data; Data Collection; Diagnosis; Disease Outbreaks; Drug Monitoring; Drug usage; Drug user; Effectiveness; Effectiveness of Interventions; Emergency response; Environment; Epidemiology; Ethnography; Evidence based intervention; Evidence based practice; Evidence based treatment; Federal Government; Fentanyl; Funding; Goals; HIV Seronegativity; HIV Seropositivity; HIV/HCV; Harm Reduction; Health; Health Services Accessibility; Healthcare Systems; Hospitals; Individual; Infrastructure; Injections; Interdisciplinary Study; Intervention; Interview; Journals; Link; Longitudinal cohort study; Maintenance Therapy; Monitor; Morbidity - disease rate; National Institute of Drug Abuse; Natural History; North America; Opioid; Opioid agonist; Opioid replacement therapy; Outcome; Overdose; Pharmaceutical Preparations; Population; Public Health; Qualitative Methods; Research; Research Infrastructure; Risk; Sampling; Services; Shapes; Site; Social Sciences; Strategic Planning; Supervision; Techniques; Training Programs; Treatment outcome; United States; Youth; addiction; base; cohort; community partnership; cost; epidemiology study; experience; implementation science; innovation; insight; interdisciplinary collaboration; mortality; novel; opioid agonist therapy; opioid epidemic; opioid injection; opioid overdose; opioid use; opioid use disorder; opioid user; programs; public health emergency; public health intervention; recruit; response; scale up; social structure

PROJECT SUMMARY/ABSTRACT North America’s opioid epidemic is a major driver of morbidity and mortality, with opioid-related overdoses becoming the leading cause of accidental death and opioid injecting driving HIV and hepatitis C (HCV) outbreaks. To date, there has been a lack of research into individual and extra-individual influences on the implementation and effectiveness of comprehensive and innovative responses to the opioid epidemic. As a consequence, there is a lack of understanding regarding how to optimize the response to the opioid epidemic, as well as the combination of interventions that are most effective in reducing opioid-related harms. Based in Vancouver, Canada, the proposed research will employ an innovative ethno-epidemiological approach to explore: (1) the implementation of innovative and comprehensive opioid-focused interventions and their impact on opioid-related outcomes; (2) the impact of the integration of evidence-based practices in the management of opioid use disorders (OUD) across the continuum of care on addiction treatment outcomes; and, (3) social, structural, and environmental influences on access to and retention in evidence-based treatment, and the onward impact on opioid-related outcomes. As the site of one of North America’s most comprehensive responses to the opioid epidemic, Vancouver is the ideal setting to undertake the proposed research. Vancouver has implemented innovative opioid-focused interventions that are currently being considered – but are not yet available – elsewhere in the US and Canada, including: supervised injection services; low-threshold opioid agonist therapies; opioid maintenance therapy; and, fentanyl-based drug checking and monitoring services. Additionally, locally-developed clinical practice guidelines for the management of OUD (recently profiled in JAMA) are being implemented across acute, residential, and community care settings alongside other changes to the healthcare system, including the systematic integration of opioid-focused treatment and harm reduction programming into hospital settings. The proposed study will be nested within the research infrastructure of the British Columbia Centre for Excellence in HIV/AIDS, which includes three NIDA-funded, longitudinal cohort studies that include opioid-using PWUD (HIV-negative and HIV-positive) and drug-using street-involved youth (SY) and are linked to external health and spatial data. Thus, this approach offers a ‘value-added’ opportunity to harness these cohort studies to undertake epidemiologically and spatially-informed sampling and targeted recruitment of PWUD and SY and collect qualitative data that can be triangulated with cohort-based and external data. Extending our ethno- epidemiological research to examine this comprehensive response to the opioid epidemic will result in a more complete understanding of influences on opioid-focused interventions than is possible through epidemiological research alone. The proposed research is aligned with the NIDA Strategic Plan (2016-2021), and will generate evidence that will be critical to informing the optimization and scale-up of the response to the opioid epidemic.

项目摘要/摘要 北美的阿片类药物流行是发病率和死亡率的主要驱动力，阿片类药物相关的过量服用 成为意外死亡和阿片类药物注射艾滋病毒和丙型肝炎（HCV）暴发的主要原因。 迄今为止，缺乏对实施个人和个人影响的研究 对阿片类药物流行的全面和创新反应的有效性。结果， 缺乏关于如何优化对阿片类药物流行的反应以及 最有效地减少阿片类药物相关危害的干预措施的组合。总部位于温哥华 加拿大，拟议的研究将采用创新的民族流行学方法来探索：（1） 实施创新和全面的以OIOID为重点的干预措施及其对OIOID相关的影响 结果； （2）基于证据实践在阿片类药物使用管理中的整合的影响 在成瘾治疗结果的整个护理中疾病（OUD）； （3）社会，结构性和 环境对获得循证治疗的获取和保留的影响，以及对 与OOPIOED相关的结果。作为北美最全面反应之一的植物剂的所在地 流行病，温哥华是进行拟议研究的理想场所。温哥华已经实施 目前正在考虑但尚不可用的创新的OIOID注重干预措施 - 在美国和加拿大的其他地方，包括：监督注射服务；低阈值阿片类药物激动剂 疗法；阿片类药物维持疗法；以及基于芬太尼的药物检查和监测服务。此外， OUD管理的本地开发的临床实践指南（最近在JAMA中进行了介绍）正在 跨急性，居民和社区护理环境以及医疗保健的其他更改 系统，包括以阿片类药物为中心的治疗和减少伤害编程的系统整合到 医院设置。拟议的研究将嵌套在不列颠哥伦比亚省的研究基础设施中 艾滋病毒/艾滋病卓越卓越中心，其中包括三项NIDA资助的纵向队列研究，包括 Opioid-us-using Pwud（HIV阴性和HIV阳性）和吸毒的街道涉及青年（SY），并与 外部健康和空间数据。那就提供了利用这些队列的“增值”机会 研究在流行病学和空间知名的采样以及针对性的PWUD和针对性招募的研究和 SY并收集可以使用基于队列和外部数据进行三角测量的定性数据。扩展我们的民族 流行病学研究以检查对阿片类药物流行的这种全面反应将导致更多 通过流行病学，完全了解对阿片类药物的干预措施的影响 仅研究。拟议的研究与NIDA战略计划（2016-2021）保持一致，并将产生 对于告知对阿片类药物流行反应的优化和扩展至关重要的证据。