The short and long-term dynamics of opioid/stimulant use: Mixed methods to informoverdose prevention and treatment related to polysubstance use

阿片类药物/兴奋剂使用的短期和长期动态：与多物质使用相关的过量预防和治疗的混合方法

• 批准号: 10590209
• 负责人: DANIELLE GERMAN
• 金额: $ 215.81万
• 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: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590209
• 关键词: Accidental Injury; Acquired Immunodeficiency Syndrome; Address; Area; Behavioral; Cause of Death; Cessation of life; Clinical; Clinical Data; Cocaine; Cohort Studies; Communities; Data; Data Collection; Data Sources; Ecological momentary assessment; Enrollment; Fentanyl; Foundations; Funding; Goals; Helping to End Addiction Long-term; Individual; Injecting drug user; Injections; Intervention; Intravenous; Joints; Knowledge; Laboratories; Link; Longitudinal trends; Methods; National Institute of Drug Abuse; Nature; North America; Opiate Addiction; Opioid; Overdose; Overdose reduction; Participant; Pattern; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Policies; Prevention; Protocols documentation; Public Health; Qualitative Research; Readiness; Recording of previous events; Research; Research Design; Research Methodology; Risk; Role; Running; Sampling; Services; Standardization; Stimulant; Substance Use Disorder; System; Time; Time trend; Treatment outcome; United States; United States National Institutes of Health; base; cohort; design; evidence base; experience; follow-up; healing; high risk; implementation strategy; improved; improved outcome; innovation; machine learning method; mortality; non-opioid analgesic; opioid epidemic; opioid misuse; opioid mortality; opioid use; opioid use disorder; opioid user; overdose death; overdose prevention; overdose risk; polysubstance use; prevention service; recruit; response; social determinants; stimulant use; substance use treatment; synthetic opioid; theories

Project Summary. Overdose deaths surpassed 100,000 in the United States in 2020. While opioid-related deaths largely attributable to fentanyl continue to rise, deaths involving stimulants, including cocaine, have increased by over 300% since 2013. A growing driver of the continued overdose crisis in the US is the role of concurrent use of multiple substances. Although there are pharmacological treatments to address opioid use disorder, few evidence-based options are available for addressing concurrent stimulant use among people using opioids. Understanding the dynamics of polysubstance use, particularly opioid and stimulant co-use, and the role of treatment with respect to the dynamics of co-use, is critical to inform ongoing overdose prevention. Yet, there are major gaps in our knowledge regarding the patterns and trajectories of opioid and stimulant co- use and their role in overdose. There is an urgent need to characterize the longitudinal nature of polysubstance use, treatment utilization, and overdose in community-based samples. The overarching objective of this proposal is to further our understanding of both long- and short-term patterns of opioid/stimulant use and examine the longitudinal relationship between co-use of opioids/stimulants and substance use treatment and non-fatal and fatal overdose over time, in order to inform treatment and overdose prevention services. We propose the following three specific aims: 1) To characterize long-term patterns of opioid and stimulant co-use and examine the relationship between trajectories of co-use, substance use treatment, overdose and mortality; 2) To examine real-time short-term patterns and transitions in and out of opioid and stimulant co-use and their association with substance use treatment and overdose; and 3) To assess opportunities and readiness for expanding and strengthening service capacity related to treatment and overdose among those with different patterns of opioid/stimulant use. To achieve these aims, we will leverage over 30 years of behavioral, laboratory and clinical data from among over 5,000 people who inject drugs within the AIDS Linked to the IntraVenous Experience (ALIVE) cohort to examine long-term trends and the social determinants of concurrent opioid/stimulant use. Supplemented with new recruitment of the Stimulant Opioid Non-Injection Cohort (SONIC), we will conduct new ecological momentary assessments in both samples to examine micro-patterns of use and employ state-of-the-art machine learning methods to identify patterns and their association with treatment and overdose over time in this community-based sample at high risk of overdose. Qualitative research with stakeholders and people with differing patterns of opioid/stimulant co-use will highlight gaps and challenges within the service system and identify specific implementation strategies to increase capacity to address heterogeneous concurrent opioid/stimulant use and related needs. The results of this study will provide evidence to inform intervention and policy to improve outcomes for people who use multiple substances with the goal of reducing overdose deaths in the US in the context of synthetic opioids.

项目摘要。服用过量死亡在2020年美国超过100,000。 芬太尼基本上的死亡继续升高，包括可卡因在内的兴奋剂的死亡已有 自2013年以来，增长了300％以上。美国持续过量危机的驱动力越来越多。 同时使用多种物质。尽管有药理治疗方法可以解决阿片类药物的使用 疾病，几乎没有证据的选择可用于解决人们的同时兴奋剂使用 使用阿片类药物。了解使用多物质使用的动态，尤其是阿片类药物和兴奋剂共同使用，以及 治疗在共同利用动力学方面的作用对于告知正在进行的预防过量的情况至关重要。 然而，关于阿片类药物和刺激性共同的模式和轨迹的知识，我们的知识存在很大的差距 使用及其在用药过量中的作用。迫切需要表征polysubstance的纵向性质 在基于社区的样本中使用，治疗利用和过量。这个总体目标 提议是为了进一步了解阿片类药物/兴奋剂的长期和短期模式以及 检查阿片类药物/兴奋剂的共同使用与物质使用治疗与药物的纵向关系 随着时间的流逝，非致命和致命的服用过量，以告知治疗和预防服务过量。我们 提出以下三个特定目的：1）表征阿片类药物和兴奋剂共同使用的长期模式 并检查共同使用，药物治疗，过量和死亡率的轨迹之间的关系； 2）检查实时的短期模式和过渡在阿片类药物和兴奋剂共同使用及其中 与药物使用治疗和过量相关； 3）评估机会和准备 扩大和增强与治疗和服用过量相关的服务能力 阿片类药物/兴奋剂的使用模式。为了实现这些目标，我们将利用超过30年的行为， 来自5,000多名注射毒品的人中的实验室和临床数据 静脉经历（活着）的队列，以检查长期趋势和并发的社会决定因素 阿片类药物/兴奋剂的使用。补充了刺激性阿片类药物非注入队列的新招募 （Sonic），我们将在两个样品中进行新的生态瞬时评估以检查微观图案 使用并采用最先进的机器学习方法来识别模式及其与之关联 随着时间的推移，在这个基于社区的样本中随着时间的流逝而过量服用过量的样本。定性 与利益相关者和具有不同模式的阿片类药物/兴奋剂共同使用的人进行的研究将突出差距和 服务系统内的挑战并确定具体的实施策略，以提高能力 解决异质的并发阿片类药物/兴奋剂的使用和相关需求。这项研究的结果将 提供证据以告知干预和政策以改善使用多重人的结果 在合成阿片类药物的背景下，其目的是减少美国过量死亡的目的。