Navigating the Fentanyl Age with Community Drug Checking

通过社区药物检查引领芬太尼时代

• 批准号: 10524801
• 负责人: TRACI C GREEN
• 金额: $ 38.16万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10524801
• 关键词: Achievement; Address; Affect; Age; Agreement; Anatomy; Area; Behavioral Sciences; Benzodiazepines; Blood Circulation; Buprenorphine; COVID-19; COVID-19 pandemic; Caring; Censuses; Characteristics; Clinical; Communities; Community Pharmacy; Consumption; Data; Data Set; Devices; Diagnosis; Dose; Drops; Drug usage; Drug user; Emergency Situation; Environment; Epidemiology; Evidence based treatment; Fentanyl; Harm Reduction; Head; Health; Hospitals; Illicit Drugs; Incidence; Individual; Intervention; Laws; Lead; Leadership; Learning; Life; Link; Maintenance; Massachusetts; Measures; Methadone; Modeling; Naloxone; Observational Study; Opioid; Overdose; Pathway interactions; Patients; Perception; Persons; Pharmaceutical Preparations; Pharmacy facility; Powder dose form; Prevention; Property; Provider; Public Health; Regimen; Regulation; Research; Rhode Island; Risk; Role; Sampling; Scientist; Severities; Site; Statutes and Laws; Stimulant; Structure; Suboxone; Supervision; Surveys; System; Testing; Time; Treatment Protocols; Withdrawal; addiction; analog; care seeking; cohort; community organizations; community setting; detection limit; epidemiologic data; epidemiology study; experience; innovation; insight; interest; lipophilicity; member; multidisciplinary; non-opioid analgesic; novel strategies; opioid use disorder; overdose risk; pill; polysubstance use; programs; success; synergism; test strip; uptake; waiver

Project Summary The drug supply is in enormous flux with illicitly manufactured fentanyl (IMF) and analogs creating a deadly environment for people who use drugs (PWUD). Claiming 93,311 lives in 2020, IMF is the underlying driver of the current crisis. Its fast onset leaves little time for emergency intervention and its presence as the dominant opioid in circulation undermines evidence-based treatments. Rhode Island (RI) is a site of early IMF devastation, subject of much epidemiologic investigation about IMF, and an innovation hub for expanded access to lifesaving naloxone and medications for opioid use disorder (MOUD) and structures to better provide them. Two recent innovations show promise even with IMF’s endemicity and the COVID-19 pandemic because they address the illicit drug supply head-on: non-traditional MOUD induction pathways and community drug checking. But treatment success may be undermined by the illicit drug supply unless we learn how to navigate it. One novel approach to doing so is with community drug checking. Drug checking gives insights into what drugs people use, engages PWUD in relevant exchange of health information, and generates data that could inform treatment. Application of these data for epidemiologic research to help better understand exposure, identify risk, measure consequence and consideration of their role in a clinical setting to inform treatment have not been examined. We propose an observational study that leverages recently acquired devices and capacities to carry out research on drug checking, multiple linkable individual level datasets, and state law and public health leadership supportive of drug checking. Consistent with the RFA, we seek to uncover how characteristics of IMF in the drug supply influence treatment regimens and ongoing drug use and risk in people intentionally or unwittingly using polysubstances (topics 2 and 4). Specific aims are to: Aim 1) Examine the anatomy of the illicit drug supply by establishing a community drug checking cohort (n=600) to learn how: a) IMF’s presence, form (i.e., powder, counterfeit pill), and potency in the opioid supply affect ongoing use and overdose risk; b) IMF’s presence in non-opioid drugs like stimulants affects use, overdose risk and clinical severity of health consequences; and c) use of drug checking affects uptake of MOUD. [UG3 and UH3]. Aim 2) Document clinicians’ perceptions about drug checking, and their experiences, innovations, barriers and facilitators of induction of patients onto MOUD, including micro- and macro-dosing, in RI. [UH3] Aim 3) Assess among community drug checking cohort members a) which drug supply characteristics are associated with ongoing drug use, overdose and MOUD interest; b) what drug supply factors impact incidence of induction problems like precipitated withdrawal and successful retention in buprenorphine care using administrative data. [UH3] Findings will help inform prevention and intervention approaches to the drug supply in IMF endemic areas, determine engagement in and clinical utility of community drug checking, and help identify factors influencing poor treatment experience and better retention.

项目摘要 该药物供应量很大，芬太尼（IMF）不合格，类似物产生致命的类似物 使用毒品的人的环境（PWUD）。国际货币基金组织在2020年夺取93,311寿命，是 当前的危机。它的快速发作几乎没有时间进行紧急干预及其作为主要的存在 循环中的绿核酸会破坏基于证据的治疗。罗德岛（RI）是IMF早期的地点 破坏性，关于IMF的许多流行病学调查的主题，以及用于扩展的创新中心 获得救生纳洛酮和阿片类药物使用障碍（MOUD）的药物，以及更好地提供的结构 他们。即使是IMF的地方性和COVID-19的大流行，最近的两项创新也表现出希望，因为 他们正面处理非法药物供应：非传统的穆德归纳途径和社区药物 检查。但是，除非我们学习如何导航，否则非法药物供应可能会破坏治疗成功 它。一种新颖的方法是与社区药物检查。药物检查可以深入了解什么 人们使用的毒品，参与相关的健康信息交换，并生成可能 告知治疗。将这些数据应用于流行病学研究以帮助更好地了解暴露， 确定风险，衡量结果和考虑其在临床环境中的作用以告知治疗 没有被检查。我们提出了一项考试研究，该研究最近利用了最近获得的设备和能力 进行药物检查，多个可链接的个人级别数据集以及州法律和公众的研究 健康领导支持药物检查。与RFA一致，我们试图发现特征如何 IMF在药物供应中的影响治疗方案和持续的药物使用和有意的毒品使用和风险 或不知不觉地使用polysubstances（主题2和4）。具体目的是：目标1）检查 通过建立社区药物检查队列（n = 600）来了解如何：a）IMF的存在， 形式（即粉末，假药）和阿片类药物供应的效力会影响持续使用和过量的风险； b） 国际货币基金组织在非阿片类药物中的存在（如兴奋剂）会影响使用，过量的风险和健康的临床严重程度 结果; c）使用药物检查会影响穆德的吸收。 [UG3和UH3]。目标2）文件 临床医生对药物检查的看法及其经验，创新，障碍和促进者 在RI中将患者诱导到MOUD上，包括微剂量和宏观剂量。 [UH3]目标3）评估 社区药物检查队列成员a）哪些药物供应特征与正在进行的 吸毒，服用过量和兴趣； b）哪些药物供应因素会影响诱导问题的强度 例如使用管理数据在丁丙诺啡护理中的宝贵戒断和成功保留。 [UH3] 调查结果将有助于告知预防和干预方法，以了解IMF内在地区的药物供应， 确定社区药物检查的参与和临床实用性，并帮助确定影响的因素 治疗经验差，保留更好。