Dealers, Detectives, and People Who Use Drugs: Triangulating Perspectives to Understand COVID-19’s Impact on the Rural Appalachian Drug Market and Mitigate Downstream Overdose Risk

经销商、侦探和吸毒者：从三角角度了解 COVID-19 对阿巴拉契亚农村毒品市场的影响并降低下游用药过量风险

• 批准号: 10678905
• 负责人: Rachel Vickers-Smith
• 金额: $ 19.08万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10678905
• 关键词: Address; Affect; Appalachian Region; Area; Attenuated; Attitude; COVID-19; COVID-19 impact; COVID-19 pandemic; Characteristics; Collaborations; Communities; Data; Detection; Disease Outbreaks; Drug usage; Drug user; Emergency medical service; Fentanyl; Fostering; Funding; Goals; Harm Reduction; Health; Individual; Intervention; Interview; Kentucky; Law Enforcement; Life; Marketing; Measures; Methods; Naloxone; Natural Disasters; Overdose; Participant; Persons; Pharmaceutical Preparations; Policies; Recommendation; Recording of previous events; Research; Research Infrastructure; Risk; Risk Factors; Rural; Rural Appalachia; Rural Population; Services; Social Distance; Time; Translating; United States Substance Abuse and Mental Health Services Administration; Work; acceptability and feasibility; analog; community partnership; community transmission; coronavirus disease; drug market; drug use vulnerability; experience; fentanyl overdose; fentanyl test; fentanyl use; high risk; improved; novel; opioid epidemic; overdose death; overdose risk; peer; post-COVID-19; resilience; response; scale up; stay-at-home order; substance use; test strip; tool

Abstract: From June 2019 to May 2020, the US saw the highest number of OD deaths ever recorded in a 12- month period, with a heightened increase from March-May 2020 when control measures were first implemented. This translated to a 30% increase in the number of overdose deaths from 2019 to 2020. Kentucky, an epicenter of the opioid epidemic, had a 56% increase in the number of overdose deaths over the same period: the second greatest increase nationwide, and the highest number of fatal overdoses the state has ever recorded. Various factors have likely played a role in this surge. For example, stay-at-home orders and social distancing practices may result in PWUD using drugs in isolation more often – a risk factor for fatal OD given the limit to bystanders’ ability to administer naloxone and/or call emergency services. Early indications from data on COVID have some positing that drug market changes may impact individual level vulnerability to OD. In Kentucky, there was a 102% increase in fentanyl-involved OD deaths from Jan-Sept 2020 compared to the same period in 2019, suggesting that an influx of fentanyl in the drug supply has driven the recent increase in ODs. In response to the urgent need for intervention, the goal of this proposal is to understand the changes in the illicit fentanyl market brought about by COVID and simultaneously work to identify harm reduction strategies to reduce PWUD vulnerability and foster resilience to these changes. This proposal is timely not only in that it responds to an urgent, COVID-related surge in fatal ODs, but also because it aligns with a period of mass scale-up of SAMHSA-funded fentanyl test strip (FTS) services in Kentucky. The proposed mixed-methods, community-engaged R21 study, led by a scientific team with extensive experience in rural substance use research, will yield urgently needed, local data on harm reduction strategies that could curb the historic spike in fentanyl-related ODs in rural Appalachia by achieving the following aims: Aim 1. Characterize COVID’s effect on the illicit fentanyl market and potential fentanyl-related harm reduction strategies (i.e., FTS) in Appalachian Kentucky through qualitative interviews with state and local law enforcement and local harm reduction staff. Aim 2. Identify individual-level characteristics of rural PWUD most vulnerable and resilient to pre-/post-COVID changes in fentanyl use and OD risk through an analysis of existing longitudinal data spanning the pre-/post-COVID period. Aim 3. Describe COVID’s impact on the local illicit fentanyl market and OD risk and explore attitudes toward potential harm reduction strategies (e.g., FTS, peer- and dealer-driven distribution of FTS) through qualitative interviews with people who sell drugs and PWUD identified as most vulnerable and most resilient to COVID-related changes in the Aim 2 analysis. Subaim 3a. Examine acceptability of an FTS intervention among Aim 3 participants using a small pilot with pre and 1-month post qualitative interviews.

摘要：从 2019 年 6 月到 2020 年 5 月，美国 OD 死亡人数创下 12 年来最高记录。 月期间，从2020年3月至5月首次采取控制措施时胃肠道增加 这意味着 2019 年至 2020 年服药过量死亡人数增加了 30%。 肯塔基州是阿片类药物流行的中心，该州因服用药物过量死亡的人数较上年增加了 56% 同期：全国第二大增幅，吸毒过量致死人数最高的州 有记录表明，多种因素可能在这一激增中发挥了作用，例如，居家令。 保持社交距离的做法可能会导致残疾人士更频繁地单独使用毒品——这是致命的危险因素 OD 限制了旁观者施用纳洛酮和/或提前呼叫紧急服务的能力。 新冠病毒数据表明，药品市场的变化可能会影响个人水平 在肯塔基州，1 月至 9 月因芬太尼导致的 OD 死亡人数增加了 102%。 2020 年与 2019 年同期相比，表明芬太尼大量涌入毒品供应推动了 为应对近期 OD 增加的迫切需要，本提案的目标是 了解新冠疫情给非法芬太尼市场带来的变化，同时努力 确定减少危害的策略，以减少残疾人士的脆弱性并增强对这些变化的抵御能力。 该提案是及时的，不仅因为它应对了与新冠病毒相关的致命 OD 的紧急激增，还因为 它与 SAMHSA 资助的肯塔基州芬太尼试纸 (FTS) 服务大规模扩大的时期相一致。 拟议的混合方法、社区参与的 R21 研究，由经验丰富的科学团队领导 在农村药物使用研究中，将产生迫切需要的有关减少危害战略的当地数据，这些数据可以 通过实现以下目标，遏制阿巴拉契亚农村地区芬太尼相关消耗臭氧层物质历史性激增：目标 1。 描述新冠病毒对非法芬太尼市场的影响以及潜在的芬太尼相关危害减少 通过对州和地方法律进行定性访谈，了解阿巴拉契亚肯塔基州的策略（即 FTS） 目标 2. 确定农村残疾人士的个人特征。 通过对芬太尼使用和 OD 风险的分析，了解新冠疫情前后芬太尼使用和 OD 风险的脆弱性和弹性 目标 3. 描述新冠疫情对当地的影响。 非法芬太尼市场和 OD 风险，并探讨对潜在危害减少策略（例如 FTS、 同行和经销商驱动的 FTS 分销）通过对销售毒品的人进行定性访谈 在目标 2 分析中，PWUD 被认为是最容易受到新冠肺炎相关变化影响且最具弹性的地区。 Subaim 3a。使用预先设定的小型试点检查 FTS 干预在 Aim 3 参与者中的可接受性。 以及为期 1 个月的定性访谈。