Preferences and predictors driving opioid-involved polysubstance use profiles and trajectories: Implications for improving care

驱动阿片类药物相关多物质使用概况和轨迹的偏好和预测因素：对改善护理的影响

• 批准号: 10584684
• 负责人: Lara Nicole Coughlin
• 金额: $ 233.94万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 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 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10584684
• 关键词: Address; Administrator; Adult; Affect; African American; African American population; Alcohols; Area; Automobile Driving; Behavior; Behavior Therapy; Black race; Caring; Cessation of life; Characteristics; Clinical; Communities; Complement; Complex; Data; Emergency department visit; Enrollment; Environment; Family history of; Fentanyl; Frequencies; Goals; Health; Health Personnel; Health system; Healthcare Systems; Individual; Intervention; Interview; Intravenous; Measures; Medicine; Mental Health Services; Michigan; Naloxone; Opioid; Outcome; Overdose; Paper; Participant; Patients; Pattern; Persons; Pharmaceutical Preparations; Policies; Population; Population Heterogeneity; Prospective cohort study; Provider; Psyche structure; Public Health; Race; Research; Risk; Risk Behaviors; Sampling; Stimulant; Structure; Subgroup; Substance Use Disorder; Time; Translations; Treatment outcome; United States; Withdrawal; Work; barrier to care; base; behavioral economics; clinical care; cohort; community-level factor; comorbidity; contingency management; experience; family support; follow-up; health care service utilization; health care settings; high risk; improved; improved outcome; individualized medicine; innovation; insight; mortality; novel; opioid use disorder; overdose prevention; overdose risk; personalized care; physical conditioning; policy implication; polysubstance use; preference; recruit; risky driving; social; social factors; stimulant use; substance use; synthetic opioid; theories; treatment services; uptake; willingness

Project Summary/Abstract Recent changes in overdose mortality are driven by rapid increases in polysubstance-involved deaths, most often including opioids followed by stimulants. Prior studies have found important individual (e.g., Black/African American race, comorbid mental/physical health), social (e.g., family supports), and community factors (e.g., treatment availability) associated with PSU, treatment, and outcomes. However, little is known about the modifiable individual-level motivators (e.g. use to alleviate withdrawal) and preferences driving high- risk polysubstance use (PSU) behaviors (e.g., intravenous use, higher frequency of opioid-involved PSU, intentional use of synthetic opioids, and simultaneous use of substances), which is important to inform and tailor treatment services. Behavioral economic (BE) theory provides a novel framework and objective measures to understand substance use preferences, emphasizing substance use is impacted by drug valuation (i.e., demand) and devaluing of uncertain negative outcomes (e.g., overdose risk) in complex environments and can inform clinical care. This is especially critical given that people with opioid-involved PSU are among the least likely to receive effective overdose prevention or treatments. As we have shown, although >85% of people who died from opioid, stimulant or alcohol-involved overdose are seen in healthcare settings (e.g., primary and mental health care), only a tiny fraction receive effective care, suggesting new strategies are needed that can be implemented in health systems, an important common touchpoint for this population. Data are critically needed to understand these intricate individual-level patterns, motivators and preferences driving PSU, along with known community and social factors, to improve care for people with opioid-involved PSU. We will conduct a prospective cohort study (N=400), recruiting a diverse sample of adults with opioid- involved PSU (over-sampling stimulant co-use and Black/African Americans to enhance representation) from 2 large health systems in Michigan. Following baseline enrollment, we will collect weekly detailed data to reliably capture nuanced and dynamic patterns and motivators of use and co-use (e.g., simultaneous or sequential, overdose risk behaviors, etc.) over four weeks. Additional measures across baseline, 4-,8-, and 12-months (e.g., behavioral economic choice preferences, comorbid mental/physical health, functioning, other social and community factors, and treatment use) will provide comprehensive information on profiles and longitudinal trajectories of PSU behaviors and treatment. Cohort data will be complemented by stakeholder interviews to elucidate patient and provider perspectives on PSU and how to tailor strategies (e.g., naloxone and low-barrier MOUD treatment) to enhance uptake. This project will have high public health impact by providing critical new insights on motives and patterns of PSU, BE choice preferences across PSU profiles, as well as nuanced patterns and trajectories of PSU and treatment to inform actionable strategies that can be implemented in health systems to improve health and outcomes across the diverse population of people with PSU.

项目摘要/摘要 过量死亡率的最新变化是由涉及多元固定的死亡的快速增加而驱动的， 通常包括阿片类药物，然后是兴奋剂。先前的研究发现了重要的个体（例如 黑人/非裔美国人种族，合并的心理/身体健康），社会（例如家庭支持）和社区 与PSU，治疗和结果相关的因素（例如，治疗可用性）。但是，鲜为人知 关于可修改的个人级动机（例如，用于减轻戒断），并偏爱推动高级的偏好 风险多物质使用（PSU）行为（例如静脉内使用，阿片类药物涉及的PSU的频率较高， 有意使用合成阿片类药物和同时使用物质），这对于告知和 裁缝治疗服务。行为经济（BE）理论提供了一个新颖的框架和客观 了解药物使用偏好的措施，强调使用物质受到药物的影响 复杂的估值（即需求）和不确定的负面结果（例如过量风险）的贬值 环境，可以为临床护理提供信息。考虑到患有阿片类药物参与PSU的人 是最不可能接受有效的预防或治疗方法之一。正如我们所表明的 > 85％的人死于阿片类药物，刺激性或涉及酒精的过量的人在医疗机构中看到 （例如，初级和精神卫生保健），只有一小部分获得有效的护理，这表明新策略是 需要在卫生系统中实施，这是该人群的重要常见接触点。数据 要理解这些复杂的个人级别模式，动力和偏好驱动的需要至关重要 PSU以及已知的社区和社会因素，以改善对阿片类药物涉及PSU的人的护理。 我们将进行一项前瞻性队列研究（n = 400），招募有阿片类药物的成年人样本 涉及2个 密歇根州的大型卫生系统。在基线注册之后，我们将每周收集每周的详细数据以可靠 捕获使用和共同使用的细微和动态模式和动机（例如，同时或顺序， 过量的风险行为等）在四个星期内。基线，4-，8和12个月的其他措施 （例如，行为经济选择偏好，精神/身体健康，功能，其他社会和其他社会和 社区因素和治疗使用）将提供有关概况和纵向的全面信息 PSU行为和治疗的轨迹。利益相关者的访谈将补充队列数据 阐明患者和提供者对PSU的观点以及如何量身定制策略（例如，纳洛酮和低障碍 moud处理）以增强摄取。该项目通过提供关键的新项目将产生巨大的公共卫生影响 对PSU动机和模式的见解，是PSU概况的选择偏好，以及细微差别 PSU和治疗的模式和轨迹，以告知可行的策略，可以实施 卫生系统，以改善PSU患者多样的人群的健康和成果。