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.

项目概要 毒品供应不断变化，非法制造的芬太尼 (IMF) 和类似物造成了致命的后果。 到 2020 年，国际货币基金组织将导致 93,311 人丧生，这是这一问题的根本驱动力。 当前的危机爆发迅速，几乎没有时间进行紧急干预，而且其作为主导力量的存在。 阿片类药物的流通破坏了循证治疗。罗德岛州 (RI) 是早期 IMF 的所在地。 破坏，国际货币基金组织大量流行病学调查的主题，以及扩大的创新中心 获得救生纳洛酮和治疗阿片类药物使用障碍 (MOUD) 的药物以及更好地提供服务的结构 即使在国际货币基金组织的流行和新冠肺炎 (COVID-19) 疫情肆虐的情况下，最近的两项创新也显示出了希望。 他们正面解决非法药物供应问题：非传统 MOUD 诱导途径和社区毒品 但除非我们学会如何应对，否则非法药物供应可能会损害治疗的成功。 一种新颖的方法是通过社区药物检查来了解什么。 人们使用的药物，让 PWUD 参与相关的健康信息交换，并生成可以 为流行病学研究应用这些数据，以帮助更好地了解暴露情况， 识别风险、衡量后果并考虑其在临床环境中的作用，为治疗提供信息 我们提出了一项利用最近购买的设备和能力的观察性研究。 开展药物检查、多个可链接的个人级别数据集以及州法律和公共领域的研究 与 RFA 一致，卫生领导层支持药物检查，我们力求揭示其特征。 药物供应中国际货币基金组织的影响故意影响人们的治疗方案和持续的药物使用和风险 或无意中使用多物质（主题 2 和 4）。具体目标是： 目标 1) 检查物体的解剖结构。 通过建立社区毒品检查队列（n=600）来了解非法毒品供应，以了解如何：a）国际货币基金组织的存在， 阿片类药物供应的形式（即粉末、假药丸）和效力影响持续使用和过量风险； IMF 在兴奋剂等非阿片类药物中的存在会影响使用、过量风险和临床健康严重程度 后果；c) 药物检查的使用会影响 MOUD 的吸收[UG3 和 UH3]。 殖民者对药物检查的看法，以及他们的经验、创新、障碍和促进因素 在 RI 中诱导患者进行 MOUD，包括微剂量和大剂量 [UH3] 目标 3) 评估。 社区毒品检查队列成员 a) 哪些毒品供应特征与持续存在相关 药物使用、药物过量和 MOUD 兴趣；b) 哪些药物供应因素影响诱导问题的发生率 例如使用管理数据的丁丙诺啡护理中的突然戒断和成功保留[UH3]。 研究结果将有助于为国际货币基金组织流行地区的药物供应提供预防和干预方法， 确定社区药物检查的参与度和临床效用，并帮助识别影响因素 治疗体验较差，保留效果较好。