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

• 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
• 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

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-19-19大流行期间，过量服用急剧上升，强调了迫切需要了解 灾难对过量的影响。我们需要研究以确定可以防止 未来灾难中服用过量的类似增加。我们还需要了解为什么某些社区是 在灾难期间和之后，特别容易体验过量的体验崛起，以便我们可以最佳地 目标预防和灾难反应工作。我们建议将大事件理论用作以下框架：1） 研究Covid-19-19的大流行及其对过量和相关结果的影响； 2）确定政策回应 到19岁的Covid-19，影响了个体级过量的风险； 3）检查大流行如何影响 过量的风险在社区和人群之间各不相同。我们假设Covid-19遏制 政策（例如，工作场所关闭）有助于社会隔离，增加了仅食用毒品的风险 并限制获得治疗和损害减少服务的机会，从而增加了过量的风险。相反，公开 卫生（例如，带回家的MeadaDone摇摆）和对Covid-19的经济支持政策的回应（例如， 住房驱逐的暂停）可能可以轻松地使用使用毒品的人（PWUD）和 大流行带来的经济困难，阻止了健康和经济道路 大流行可能会增加过量的风险。我们假设社区具有更大的结构性 绝望的来源（例如，失业率高，贫困）以及同时经历其他人的那些 重大的社会危机（自然灾害，政治冲突，大规模枪击事件）更容易受到影响 covid-19上的过量。相反，在大流行之前制定的社会和经济政策保护 弱势群体（例如，较高的州医疗补助收入阈值）可能会降低 大流行对过量风险。我们的目的是：（1）确定当地的单个过量风险 （总体和种族/种族）在Covid-19 Health的县级海拔高度之后，2019 - 2025年发生了变化 伯恩（住院，死亡）。 （2）确定针对COVID-19的县和州级政策 在大流行中介导的感染遏制，公共卫生和经济支持 县级别的共同烧伤的变化与过量事件的变化，整体和整体和 通过种族/种族。 （3）确定哪些社区条件影响了关系的力量 在县级COVID-19烧伤的变化与整体和种族/民族的各种过量风险之间 包括：a）现有的社区结构特征（例如贫困率）； b）预先存在的政策 保护弱势群体（例如，州医疗补助计划收入阈值）； c）与犯罪相交。我们 将在全国六个PCORNET®网络中建立一个〜240万年龄在18岁以上的患者的多中心队列 跟踪社区COVID-19-Burnen对单个过量风险的影响。我们的研究结果将告知 对当前过量危机和未来灾难的反应。