A comparative evaluation of overdose prevention programs in New York City and Rhode Island

纽约市和罗德岛州药物过量预防计划的比较评估

• 批准号: 10629749
• 负责人: Magdalena Cerda
• 金额: $ 147.47万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10629749
• 关键词: Accident and Emergency department; Accidents; Acute; Address; Affect; Authorization documentation; Businesses; Censuses; Cities; Client; Clinic; Communities; Consumption; Control Groups; Cost Effectiveness Analysis; Cost Savings; Country; Criminal Justice; Data; Data Set; Data Sources; Disease; Drug usage; Drug user; Economic Conditions; Economics; Education; Effectiveness; Environment; Ethnography; Evaluation; Event; Evidence based treatment; Fatality rate; Future; HIV; Harm Reduction; Health; Health Priorities; Health Services; Healthcare; Hepatitis C; Hospitals; Human Resources; Individual; Infective endocarditis; International; Intervention; Interview; Legal; Link; Location; Measures; Medicaid; Medical; Methods; Modeling; Municipal Government; Needle Sharing; Needle-Exchange Programs; Neighborhoods; New York City; Noise; Outcome; Outcome Measure; Overdose; Participant; Persons; Pharmaceutical Preparations; Physical environment; Play; Police; Policies; Prevention program; Procedures; Program Effectiveness; Property; Prospective cohort; Public Health; Qualitative Methods; Records; Research; Rhode Island; Risk; Role; Safety; Service delivery model; Services; Shapes; Site; Skin Tissue; Social Identification; Social Policies; Social Work; Soft Tissue Infections; Statutes and Laws; Sterility; Substance Use Disorder; Supervision; System; Time; Training; United States; United States Dept. of Health and Human Services; authority; cohort; community center; community engaged research; comparative; cost; cost effectiveness; drug market; effectiveness study; ethnographic method; experience; improved; innovation; microcosting; models and simulation; mortality; multidisciplinary; novel; overdose death; overdose prevention; peer; programs; prospective; public health emergency; recovery services; referral services; response; social; treatment services

ABSTRACT More than one million people have died from accidental drug overdose in the United States (US) in the past twenty years. In response to this unabating crisis, New York City implemented the first two publicly recognized overdose prevention centers (OPCs) in the nation in November 2021. Rhode Island became the first state to authorize OPCs through state legislation and they are expected to open in late 2022. OPCs are community- based facilities that permit clients to consume pre-obtained controlled substances under the supervision of personnel who are trained to intervene in the event of an overdose. Staff at OPCs also provide safer drug consumption education, access to sterile drug use supplies, offer health and ancillary services, and provide referrals to other treatment, health, and recovery services. While research from other countries and from an unsanctioned site in the US suggest that OPCs produce individual health and community benefits, no evaluations exist of sanctioned OPCs in the US. The proposed study has extraordinarily high policy significance, as it will evaluate the public health, public safety, and community benefits—and potential unintended effects—of the first sanctioned OPCs in the US. We propose to conduct a rigorous, multi-site, multi-component evaluation of OPCs in New York City and Rhode Island in 2023-2027. At the individual level, we aim to evaluate whether a prospective cohort of 500 persons attending OPCs experience lower rates of overdose, other health problems, and emergency department use, and a higher rate of substance use disorder treatment initiation, compared to a cohort of 500 persons who do not attend OPCs (Aim 1). At the community level, we will examine whether neighborhoods surrounding the OPCs experience a greater change in overdose, measures of drug-related public disorder, and acute economic conditions following the opening of OPCs, compared to neighborhoods unexposed to OPCs (Aim 2). Third, we aim to delve into the role that the operational context, including neighborhood location, program models, and operating procedures, plays in shaping the effectiveness of OPCs using qualitative and ethnographic approaches (Aim 3). Finally, we will estimate additional costs and cost savings to the healthcare and criminal justice systems associated with OPC use, to support future cost-effectiveness analyses of OPCs (Aim 4). To accomplish these aims, we have assembled an internationally renowned investigative team and established strong, community-engaged research partnerships with harm reduction organizations in New York City and Rhode Island. As more jurisdictions throughout the US consider opening OPCs, findings from the proposed research will have critical implications for US drug policy. The study’s results will have powerful, lasting implications for communities that wish to offer OPCs, generate critical data to optimize their effectiveness, and provide models for sustainability and expansion of these interventions.

抽象的 过去，超过一百万的人因意外药物过量死亡（美国） 二十年。为了应对这一不懈的危机，纽约市实施了前两个公开认可的 2021年11月，全国预防中心（OPC）。罗德岛成为第一个的州 通过州立法授权OPC，预计他们将在2022年底开放。OPC是社区 - 基于允许客户在监督下消费预先注射的受控物质的设施 如果服用过量，接受培训可以干预的人员。 OPC的工作人员还提供更安全的药物 消费教育，获得无菌药物使用用品，提供健康和辅助服务，并提供 转介到其他治疗，健康和恢复服务。而其他国家的研究以及 美国未经许可的网站表明，OPC会产生个人健康和社区福利，没有评估 在美国存在批准的OPC。拟议的研究具有极高的政策意义，因为它将 评估第一个公共卫生，公共安全和社区利益以及潜在的意外影响 在美国批准了OPC。我们建议对OPC进行严格的多站点多组分评估 2023 - 2027年在纽约市和罗德岛。在个人层面，我们旨在评估是否 500人参加OPC的预期队列经历了较低的过量，其他健康问题， 和急诊科的使用，以及更高的物质使用障碍治疗计划，与 不参加OPC的500人组成（AIM 1）。在社区层面，我们将检查是否 OPC周围的社区经历了过量的变化，与毒品相关的公众量 与社区意外相比，OPC开放后的疾病和急性经济状况 致OPC（AIM 2）。第三，我们旨在深入研究运营环境，包括邻里的角色 位置，程序模型和操作程序，扮演着使用OPC的有效性的 定性和民族志方法（AIM 3）。最后，我们将估算额外的成本和节省的成本 与OPC使用相关的医疗保健和刑事司法系统，以支持未来的成本效益 OPC的分析（AIM 4）。为了实现这些目标，我们汇集了国际知名的 调查团队并建立了强大的社区参与研究伙伴关系，并减少了伤害 纽约市和罗德岛的组织。随着整个美国的更多司法管辖区正在考虑开放 OPC，拟议研究的发现将对美国药物政策产生关键影响。该研究的结果 将对希望提供OPC的社区具有强大的持久影响，生成关键数据以优化 它们的有效性，并为这些干预措施的可持续性和扩展提供了模型。