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 美国过去有超过一百万人因意外吸毒过量死亡 二十年来，为了应对这场持续不断的危机，纽约市实施了前两项公开承认的措施。 2021 年 11 月，全国设立药物过量预防中心 (OPC)。罗德岛州成为第一个建立药物过量预防中心 (OPC) 的州 通过州立法授权 OPC，预计将于 2022 年底开业。OPC 是社区- 允许客户在监督下消费预先获得的受控物质的设施 接受过药物过量干预培训的人员 OPC 的工作人员也提供更安全的药物。 消费教育、获得无菌吸毒用品、提供保健和辅助服务以及提供 转介至其他治疗、健康和康复服务，同时来自其他国家和机构的研究。 美国未经批准的网站表明 OPC 可产生个人健康和社区效益，但未进行评估 拟议的研究具有极高的政策意义，因为它将会在美国存在受制裁的 OPC。 评估第一个事件的公共卫生、公共安全和社区效益以及潜在的意外影响 我们建议对美国认可的 OPC 进行严格、多地点、多成分的评估。 2023-2027 年在纽约市和罗德岛州的个人层面，我们的目标是评估是否 参加 OPC 的 500 名前瞻性队列参与者的用药过量、其他健康问题、 与急诊室使用相比，物质使用障碍治疗开始率更高 由 500 名未参加 OPC 的人组成的队列（目标 1） 在社区层面，我们将检查是否。 OPC 周围的社区在服药过量、与毒品相关的公众的措施方面经历了更大的变化 与未受影响的社区相比，OPC 开放后的混乱和严重的经济状况 第三，我们的目标是深入研究运营环境（包括邻里）的作用。 位置、程序模型和操作程序，在塑造 OPC 的有效性方面发挥着重要作用 最后，我们将估计额外成本和成本节省。 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 分析（目标 4） 为了实现这些目标，我们组建了国际知名的团队。 调查团队并建立了强有力的、社区参与的研究伙伴关系以减少危害 随着美国各地越来越多的司法管辖区考虑开设。 OPC，拟议研究的结果将对美国的药物政策产生重大影响。 将对希望提供 OPC、生成关键数据以优化的社区产生强大、持久的影响 其有效性，并为这些干预措施的可持续性和扩展提供模型。