Methamphetamine injection, associated health risk, and causes of overdose deaths.

甲基苯丙胺注射、相关健康风险以及过量死亡的原因。

• 批准号: 10708813
• 负责人: ALEXANDER H KRAL
• 金额: $ 54.21万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10708813
• 关键词: Acute; Address; Adult; Amphetamines; Back; California; Cardiac; Cause of Death; Cerebral hemisphere hemorrhage; Cessation of life; Chronic; Communicable Diseases; Communities; Data; Death Certificates; Disease Outbreaks; Drug usage; Environment; Epidemic; Epidemiologist; Fentanyl; Funding; HIV; HIV diagnosis; HIV/HCV; Health; Hepatitis C virus; Hospitalization; Illicit Drugs; Indiana; Injecting drug user; Injections; Link; Massachusetts; Medical Examiners; Mental Depression; Methamphetamine; Methamphetamine overdose; Methamphetamine use disorder; Methods; Motivation; National Institute of Drug Abuse; Needle Sharing; Overdose; Pain management; Performance; Persons; Pharmaceutical Preparations; Physicians; Policy Maker; Psychiatrist; Public Health; Publishing; Records; Reporting; Research Personnel; Risk; Risk Behaviors; Sampling; San Francisco; Sedation procedure; Sexually Transmitted Diseases; Shapes; Substance Use Disorder; Surveys; Toxic effect; Toxicology; United States; Update; Urine; Ventilatory Depression; Washington; Weight; West Virginia; analog; cohort; disorder prevention; disorder risk; drug market; epidemiology study; experience; fentanyl use; follow-up; methamphetamine use; mortality; opioid epidemic; opioid mortality; overdose death; pleasure; prevent; psychostimulant; public health intervention; recruit; risk sharing; screening; sexually transmitted virus; timeline

PROJECT SUMMARY/ABSTRACT We propose to investigate motivations for methamphetamine injection, associations of its co-use with fentanyl and infectious disease risk, and the underlying causes of death for methamphetamine overdose in San Francisco (SF) and Oakland (OAK), California. All major indicators point to a steep increase in methamphetamine use in the United States (US). From 2015 to 2018, 1.6 million US adults reported past- year methamphetamine use, of which 22% reported injecting methamphetamine. When the US experienced a large increase in methamphetamine use in the late 1990s and 2000s, the motivations for its use and attendant health risks were well characterized. However, the introduction of illicitly made fentanyl into drug markets in the US in the past 5 years has significantly altered the context in which methamphetamine is now used. What is being termed the “fourth wave of the opioid epidemic” is a surge in co-use of fentanyl and methamphetamine. Anecdotal evidence suggests that fentanyl and its analogs are so potent that people are motivated to co-use methamphetamine to overcome the heavy sedation that accompanies fentanyl use. Consequently, our understanding of the motivations for methamphetamine injection must be updated within this new context. We also need to update our understanding of how people who inject methamphetamine are at increased risk for infectious diseases during the fentanyl era. While the data from the 1990s and 2000s showed increased syringe sharing and sexual risks, it is unclear whether these persist in the new wave of methamphetamine injection and its co-use with fentanyl. As opposed to opioid overdose deaths, which are caused by respiratory depression, we know little about the distribution of underlying causes of death in methamphetamine overdoses. The only US epidemiological study showed that the most common additional causes of death were cerebral hemorrhage (15%) and cardiac conditions (6%). That study predated the co- use of fentanyl, after which overdose deaths have surged. If we do not know why people who use methamphetamine are dying, we cannot address how to prevent such deaths. Aim 1: To characterize motivations for methamphetamine injection. Aim 2: To assess the association of methamphetamine and fentanyl co-use with infectious disease risk behaviors. Aim 3: To determine the distribution of underlying causes of death among people whose cause of death includes acute methamphetamine toxicity. To achieve Aims 1 and 2, we will recruit a community-based cohort of 800 people who inject drugs using targeted sampling methods in SF and OAK. We will conduct surveys at baseline and monthly for 6 months, using 7- day timeline follow-back methods. To achieve Aim 3, we will determine cause of death of all overdose fatalities involving methamphetamine from 2016 to 2024 by reviewing medical examiner records in SF (estimated N=500). Findings will provide rigorous empirical evidence to policymakers, health departments, and agencies working with people who inject methamphetamine to mitigate attendant health risks.

项目概要/摘要 我们建议调查甲基苯丙胺注射的动机及其与注射剂共同使用的关联 芬太尼和传染病的风险，以及甲基苯丙胺过量死亡的根本原因 加利福尼亚州旧金山 (SF) 和奥克兰 (OAK) 所有主要指标都显示急剧增长。 2015 年至 2018 年，美国有 160 万成年人报告吸食过甲基苯丙胺。 年使用甲基苯丙胺，其中 22% 的人报告在美国经历过注射甲基苯丙胺。 1990 年代末和 2000 年代甲基苯丙胺的使用大量增加，其使用动机和 然而，非法制造的芬太尼被引入药物中，随之而来的健康风险已得到明确描述。 过去 5 年美国市场的情况与甲基苯丙胺现在的情况有很大关系 所谓的“阿片类药物流行的第四波”是芬太尼和芬太尼的共同使用激增。 轶事证据表明芬太尼及其类似物的效力如此之大，以至于人们 动机是共同使用甲基苯丙胺来克服芬太尼使用带来的严重镇静作用。 审查后，我们对甲基苯丙胺注射动机的理解必须在 我们还需要更新对注射甲基苯丙胺的人的了解。 根据 20 世纪 90 年代和 2000 年代的数据，芬太尼时代的传染病风险增加。 显示注射器共享和性风险增加，目前尚不清楚这些是否会在新一波感染中持续存在 甲基苯丙胺注射液及其与芬太尼的共同使用与阿片类药物过量死亡相反。 由呼吸抑制引起，我们对潜在死亡原因的分布知之甚少 美国唯一的流行病学研究表明，甲基苯丙胺过量服用是最常见的。 死亡原因是脑出血（15%）和心脏病（6%）。 使用芬太尼后，如果我们不知道使用芬太尼的人为何过量，死亡人数就会激增。 甲基苯丙胺正在死亡，我们无法解决如何预防此类死亡的问题。 目标 1：描述死亡的特征。 注射甲基苯丙胺的动机 目标 2：评估甲基苯丙胺与注射的关联。 芬太尼与传染病风险行为的共同使用 目标 3：确定潜在的分布。 死亡原因包括急性甲基苯丙胺中毒的人的死亡原因。 目标 1 和 2，我们将招募 800 名以社区为基础的人群，他们使用靶向药物注射毒品 我们将使用 SF 和 OAK 中的抽样方法进行为期 6 个月的基线调查和月度调查，使用 7- 为实现目标 3，我们将确定所有用药过量的死亡原因。 通过审查旧金山法医记录，了解 2016 年至 2024 年甲基苯丙胺死亡人数 （估计 N=500）。研究结果将为政策制定者、卫生部门提供严格的经验证据。 以及与注射甲基苯丙胺的人合作以减轻随之而来的健康风险的机构。