Housing Policies and their Impact on Engagement in Substance Use Treatment and Overdose Risk during the COVID-19 Pandemic

COVID-19 大流行期间的住房政策及其对参与药物滥用治疗和过量风险的影响

• 批准号: 10710054
• 负责人: Matthew Eisenberg
• 金额: $ 75.83万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-26 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10710054
• 关键词: Accident and Emergency department; Achievement; Address; Affect; Ambulatory Care; Behavioral; Buprenorphine; COVID-19; COVID-19 impact; COVID-19 pandemic; Centers for Disease Control and Prevention (U.S.); Color; Communities; Costs and Benefits; Counseling; Data; Data Sources; Delaware; Drug usage; Emergency Situation; Ensure; Epidemiology; Ethnic Origin; FDA approved; Fatality rate; Funding; Health Care Costs; Health Services Research; Household; Housing; Income; Individual; Inpatients; Intervention; Interview; Knowledge; Legal; Life; Life Expectancy; Maryland; Measures; Medical; Methadone; Methods; Naltrexone; Outcome; Overdose; Pennsylvania; Persons; Pharmaceutical Preparations; Pharmacologic Substance; Policies; Policy Developments; Policy Maker; Policy Research; Population; Provider; Qualitative Methods; Race; Recording of previous events; Recovery; Research; Risk; Security; Services; Speed; Structural Racism; Structure; Substance Use Disorder; Time; Variant; West Virginia; addiction; administrative database; design; evidence base; experience; falls; health economics; health service use; improved; innovation; interest; medical specialties; mortality; opioid use disorder; overdose death; overdose risk; pandemic disease; population based; post-pandemic; prevent; psychiatric comorbidity; public health emergency; relapse risk; rural counties; service programs; service providers; substance use; substance use treatment; supported housing; treatment and outcome; treatment risk; treatment services

Project Summary Substance use disorder (SUD), overdose risk, and housing insecurity have reached crisis levels in the US. In 2019, over 8 million individuals met criteria for SUD, and nearly 37 million households were spending more than 30% of their income on housing. Since the start of the COVID-19 pandemic, already-high overdose mortality rates soared, and millions of households have fallen behind on their rent. Beyond initiatives focused on people without housing such as housing first, there has been a paucity of research focusing on the intersection of SUD and housing insecurity. Even less is known about whether policy attempts designed to support housing security have the potential to improve engagement in substance use treatment and reduce fatal and non-fatal overdose. Innovative housing policies enacted during the COVID-19 pandemic—including eviction moratoriums, emergency rental assistance, and legal representation to tenants facing eviction (right to counsel)—offer an unprecedented opportunity to fill this vital knowledge gap. Widespread variation across states in whether and how these policies were implemented allow them to be rigorously studied using causal methods with mechanisms and potential mechanisms explored using qualitative approaches. In Aims 1-2, we will conduct a 50-state study using a difference-in-differences approach to examine the effects of the three housing policies of interest on rates of substance use treatment and fatal and non-fatal drug overdose. Data sources for Aims 1-2 will include 50-state administrative databases capturing services delivered in the general medical sector (IQVIA LRx/Dx and HCUP) and specialty addiction treatment sector (TEDS), as well as CDC fatal drug overdose data. In Aim 3, we will conduct in-depth qualitative interviews with people with recent histories of drug use as well as providers and policy officials in urban and rural counties. Our study will yield actionable evidence to inform policy development and implementation at the intersection of housing and SUD designed to enhance engagement in addiction treatment and prevent drug overdose.

项目概要 在美国，药物使用障碍（SUD）、用药过量风险和住房不安全已达到危机水平。 2019 年，超过 800 万人符合 SUD 标准，近 3700 万家庭的支出增加 自 COVID-19 大流行开始以来，他们 30% 以上的收入用于住房，药物过量已经很高。 死亡率飙升，数百万家庭拖欠租金。 对于没有住房的人，例如住房优先，很少有研究关注 SUD 与住房不安全的交集，人们对政策尝试是否旨在解决这一问题知之甚少。 支持住房保障有可能提高药物滥用治疗的参与度并减少 COVID-19 大流行期间制定的创新性住房政策，包括致命和非致命的用药过量。 暂停驱逐、紧急租金援助以及为面临驱逐的租户提供法律代理（有权 顾问）——提供了一个前所未有的机会来填补这一广泛存在的知识空白。 国家是否以及如何实施这些政策允许使用因果关系对其进行严格研究 在目标 1-2 中，我们使用定性方法探索了具有机制和潜在机制的方法。 将使用双重差分法对 50 个州进行研究，以检验这三个州的影响 关于药物滥用治疗率以及致命和非致命药物过量数据的住房政策。 目标 1-2 的来源将包括 50 个州的行政数据库，捕获一般情况下提供的服务 医疗部门（IQVIA LRx/Dx 和 HCUP）和专业成瘾治疗部门 (TEDS) 以及 CDC 在目标 3 中，我们将对最近患有药物过量的人进行深入的定性访谈。 我们的研究将得出城市和农村县的吸毒史以及提供者和政策官员的结论。 为住房和 SUD 交叉点的政策制定和实施提供可操作的证据 旨在加强对成瘾治疗的参与并防止药物过量。