Understanding the short- and long-term effects of the COVID-19 pandemic on the overdose crisis

了解 COVID-19 大流行对药物过量危机的短期和长期影响

基本信息

批准号：
10739492
负责人：
Magdalena Cerda
金额：
$ 103.88万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-30 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10739492
关键词：
Address Adoption Adverse drug effect Affect Black Populations Black race Buffers COVID-19 COVID-19 impact COVID-19 pandemic COVID-19 pandemic effects Cessation of life Characteristics Communities Conflict (Psychology)Consumption Containment Country County Diagnosis Disasters Drug usage Drug user Economic Policy Economically Deprived Population Economics Ethnic Origin Event Fentanyl Future Harm Reduction Health Health Services Health Services Accessibility Heterogeneity Hispanic Populations Home Hospitalization Housing Incidence Income Individual Inequality Inequity Investigation Knowledge Measures Mediating Medicaid Methadone Modeling Naloxone Natural Disasters Outcome Overdose Pathway interactions Patients Pattern Pharmaceutical Preparations Policies Politics Population Poverty Prevalence Prevention Public Health Public Policy Race Relapse Research Research Design Risk Role SARS-CoV-2 infection Services Social Policies Social isolation Source Structure Subgroup Testing Unemployment Urban Community Vulnerable Populations Wages Wing Workplace aged climate change cohort drug market experience future pandemic improved insight long term consequences of COVID-19 man mass shooting mortality opioid use disorder overdose risk pandemic disease pandemic impact prevent programs residential segregation response social social disparities theories waiver

项目摘要

Overdose has risen sharply during the COVID-19 pandemic, highlighting an urgent need to understand the impact of disasters on overdose. We need research to identify the types of policy measures that can prevent a similar increase in overdose in future disasters. We also need to understand why certain communities are particularly vulnerable to experiencing rises in overdose during and after a disaster, so that we can optimally target prevention and disaster response efforts. We propose to use Big Events Theory as a framework to: 1) study the COVID-19 pandemic and its effects on overdose and related outcomes; 2) identify policy responses to COVID-19 that affected individual-level overdose risk; and 3) examine how the pandemic's impact on overdose risk varied across communities and populations. We hypothesize that COVID-19 containment policies (e.g., workplace closings) contributed to social isolation, increasing the risk of consuming drugs alone and limiting access to treatment and harm reduction services, thus increasing overdose risk. In contrast, public health (e.g., take-home methadone waivers) and economic support policy responses to COVID-19 (e.g., housing eviction moratoria) may have eased access to health services for people who use drugs (PWUD) and alleviated economic difficulties arising from the pandemic, blocking health and economic pathways through which the pandemic could increase overdose risk. We hypothesize that communities with more structural sources of despair (e.g., high rates of unemployment, poverty), and those that concurrently experienced other major societal crises (natural disasters, political conflict, mass shootings) were more vulnerable to the effects of COVID-19 on overdose. In contrast, social and economic policies enacted before the pandemic to protect vulnerable populations (e.g., higher state Medicaid income threshold) may have reduced the impact of the pandemic on overdose risk. Our Aims are to: (1) Determine how individual overdose risk in localities (overall and by race/ethnicity) changed over 2019–2025 after county-level elevations in COVID-19 health burden (hospitalizations, deaths). (2) Determine which county- and state-level policies targeting COVID-19 infection containment, public health of PWUDs, and economic support during the pandemic mediated relations between changes in county-level COVID-19 burden and changes in overdose incidence, overall and by race/ethnicity. (3) Identify which community conditions affected the strength of the relationships between changes in county-level COVID-19 burden and individual overdose risk, overall and by race/ethnicity, including: a) pre-existing community structural characteristics (e.g., poverty rate); b) pre-existing policies to protect vulnerable populations (e.g., state Medicaid program income threshold); and c) intersecting crises. We will build a multi-center cohort of ~2.4 million patients aged 18+ in six PCORnet® networks across the country to track the impact of community COVID-19 burden on individual overdose risk. Our study findings will inform the response to the current overdose crisis and to future disasters.

在 COVID-19 大流行期间，用药过量急剧增加，凸显了迫切需要了解我们需要研究来确定可以预防灾难的政策措施类型。未来灾难中药物过量的情况也会类似增加，我们还需要了解为什么某些社区会出现类似的情况。特别容易在灾难期间和灾难之后经历用药过量的增加，以便我们能够最佳地我们建议以大事件理论为框架来： 1) 研究 COVID-19 大流行及其对用药过量和相关结果的影响 2) 确定政策应对措施；影响个人用药过量风险的 COVID-19；以及 3) 研究大流行对个人用药过量风险的影响；我们努力遏制不同社区和人群的用药过量风险。政策（例如关闭工作场所）导致社会孤立，增加了单独吸毒的风险相比之下，限制获得治疗和减少伤害服务的机会，从而增加了用药过量的风险。健康（例如，带回家的美沙酮豁免）和针对 COVID-19 的经济支持政策（例如，暂停驱逐住房）可能会方便吸毒者（PWUD）和缓解大流行造成的经济困难，阻断卫生和经济途径大流行可能会增加用药过量的风险，我们在结构性更强的社区中遇到了困难。绝望的根源（例如高失业率、贫困），以及同时经历其他困难的人重大社会危机（自然灾害、政治冲突、大规模枪击事件）更容易受到影响相比之下，在大流行之前制定的社会和经济政策是为了保护服药过量。弱势群体（例如，较高的州医疗补助收入门槛）可能减少了我们的目标是： (1) 确定各地的个人用药过量风险。在县级 COVID-19 健康状况上升后，2019 年至 2025 年（总体和按种族/族裔划分）发生了变化 (2) 确定针对 COVID-19 的县级和州级政策。感染控制、残疾人士的公共卫生以及大流行期间的经济支持县级 COVID-19 负担变化与服药过量发生率变化之间的关系，总体和 (3) 确定哪些社区条件影响了关系的强度。县级 COVID-19 负担的变化与个人用药过量风险之间的总体情况和种族/民族情况，包括： a) 先前存在的社区结构特征（例如贫困率）； b) 先前存在的政策；保护弱势群体（例如，州医疗补助计划收入门槛）；以及 c) 交叉危机。将在全国六个 PCORnet® 网络中建立一个由约 240 万名 18 岁以上患者组成的多中心队列追踪社区 COVID-19 负担对个人用药过量风险的影响，我们的研究结果将为您提供信息。对当前用药过量危机和未来灾难的应对措施。