A Natural History Study of Buprenorphine Diversion, Self-Treatment, and Use of Drug Abuse Treatment Services

丁丙诺啡转移、自我治疗和药物滥用治疗服务使用的自然史研究

• 批准号: 9175607
• 负责人: Raminta Daniulaityte
• 金额: $ 56.3万
• 依托单位: WRIGHT STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-15 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9175607
• 关键词: Abstinence; Address; Area; Behavior Therapy; Buprenorphine; Clinical; Communities; Complex; Data; Data Collection; Diagnostic and Statistical Manual of Mental Disorders; Dimensions; Drug Abuse Treatment Services; Drug abuse; Drug usage; Epidemic; Frequencies; HIV; HIV risk; Health; Hepatitis B Virus; Hepatitis C virus; Heroin; Heterogeneity; Individual; Injection of therapeutic agent; Intervention; Interview; Length; Methods; Motivation; Natural History; Nature; Ohio; Opioid; Outcome; Overdose; Pattern; Pharmaceutical Preparations; Pharmacologic Substance; Pharmacotherapy; Phase; Public Health; Qualitative Research; Recording of previous events; Recruitment Activity; Reporting; Research; Risk Behaviors; Sampling; Services; Source; Structure; Testing; Withdrawal Symptom; Work; base; design; follow-up; innovation; insight; instrument; meetings; metropolitan; novel; opioid use; opioid use disorder; opioid withdrawal; overdose death; prescription drug abuse; prospective; substance abuse treatment; therapy design; trend

PROJECT SUMMARY There have been substantial increases in the use of diverted buprenorphine (BUP) in the U.S. Research suggests that increases are driven by people self-treating opioid withdrawal. A growing trend of BUP diversion represents an important, although little understood, part of the larger prescription drug abuse problem in the U.S. that is intertwined with the soaring heroin epidemic. The overall purpose of this natural history study is to describe and analyze the nature and consequences of diverted BUP use among heroin and/or non-medical pharmaceutical opioid (NMPO) users who meet criteria for DSM-5 opioid use disorder. The study will be conducted in the Dayton, Ohio, Metropolitan Area, an emerging epicenter of the heroin epidemic. The study uses a mixed-methods approach. In Phase I (formative research) qualitative data will be collected to inform Phase II data collection. Phase II (sample recruitment and longitudinal follow-up) builds on a sequential explanatory mixed-methods design. We will recruit a community-based sample of 400 people with DSM-5 opioid use disorder who have used diverted BUP in the previous 90 days. The quantitative component will include structured baseline (N=400) and follow-up interviews conducted every six months for two years. The qualitative component will include 60 semi-structured in-depth qualitative interviews with individuals selected from the larger sample based on results of Latent Class Analysis (LCA) of baseline quantitative data. The Specific Aims are to: 1) Describe key dimensions of BUP diversion, motivations and patterns of BUP and other drug use, HIV/HBV/HCV risk behaviors, history of unintentional overdose, and drug abuse treatment use. 2) Identify trajectories of diverted BUP product use over 24 months and analyze their dynamic relationship to health-related outcomes, including opioid use/non-use, HIV/HBV/HCV risk behaviors, unintentional overdose, and drug abuse treatment engagement. Understanding the nature of diverted BUP use and its effects on opioid use and utilization of substance abuse treatment services has important clinical and public health implications. The study is highly significant because it will advance our understanding of crucial scientific research questions on the mechanisms of BUP diversion and relationships between trajectories of diverted BUP use, length of abstinence from other opioids, HIV risk behaviors, unintentional overdose, and drug abuse treatment seeking and engagement. It is highly innovative because it will be the first study to provide a longitudinal, mixed-methods approach to analyze BUP diversion and trajectories of use in the context of complex interactions between self-treatment behaviors and use of drug abuse treatment services. The mixed-method design is also novel because we will use LCA analysis results to select the qualitative sample. Our research questions will provide findings with critical public health impact that could be used to inform the design of interventions to address the NMPO/heroin epidemics and issues of BUP diversion.

项目概要 美国研究中改用丁丙诺啡 (BUP) 的使用大幅增加 表明这一增长是由人们自我治疗阿片类药物戒断引起的。 BUP 转移呈增长趋势 代表了美国更大的处方药滥用问题的一个重要部分，尽管人们对此知之甚少。 美国的情况与飙升的海洛因流行交织在一起。这项自然历史研究的总体目的是 描述和分析海洛因和/或非医疗用途中 BUP 转移使用的性质和后果 符合 DSM-5 阿片类药物使用障碍标准的药物阿片类药物 (NMPO) 使用者。该研究将是 调查在俄亥俄州代顿大都市区进行，这里是海洛因流行的新兴中心。研究 使用混合方法。在第一阶段（形成性研究）中，将收集定性数据以告知 第二阶段数据收集。第二阶段（样本招募和纵向随访）建立在连续的基础上 解释性混合方法设计。我们将使用 DSM-5 招募 400 名社区样本 在过去 90 天内使用过 BUP 的阿片类药物使用障碍。定量部分将 包括结构化基线 (N=400) 和两年内每六个月进行一次的后续访谈。这 定性部分将包括对选定个人进行 60 次半结构化深入定性访谈 来自基于基线定量数据的潜在类别分析 (LCA) 结果的较大样本。这 具体目标是： 1) 描述 BUP 转移的关键维度、BUP 的动机和模式以及 其他药物使用、HIV/HBV/HCV 危险行为、无意过量用药史以及药物滥用治疗使用情况。 2) 确定 24 个月内 BUP 产品转移使用轨迹，并分析其动态关系 健康相关结果，包括阿片类药物使用/不使用、HIV/HBV/HCV 风险行为、无意过量用药、 和药物滥用治疗参与。了解 BUP 转移使用的性质及其对阿片类药物的影响 药物滥用治疗服务的使用和利用具有重要的临床和公共卫生影响。 这项研究非常重要，因为它将增进我们对关键科学研究的理解 关于 BUP 转移机制以及 BUP 转移使用轨迹之间关系的问题， 戒除其他阿片类药物的时间长度、艾滋病毒危险行为、无意过量用药和药物滥用治疗 寻求和参与。它具有高度创新性，因为它将是第一项提供纵向、 混合方法分析 BUP 转移和复杂情况下的使用轨迹 自我治疗行为与使用药物滥用治疗服务之间的相互作用。混合法 设计也很新颖，因为我们将使用LCA分析结果来选择定性样本。我们的研究 问题将提供具有重大公共卫生影响的调查结果，可用于为设计提供信息 采取干预措施解决 NMPO/海洛因流行和 BUP 转移问题。