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。 2020 年，美国因吸毒过量死亡人数超过 10 万人。 主要归因于芬太尼的死亡人数继续上升，涉及包括可卡因在内的兴奋剂的死亡人数也有所增加 自 2013 年以来增加了 300% 以上。美国持续的药物过量危机的一个日益增长的驱动因素是 同时使用多种物质。尽管有药物治疗可以解决阿片类药物的使用问题 障碍，很少有基于证据的选择可用于解决人们同时使用兴奋剂的问题 使用阿片类药物。了解多物质使用的动态，特别是阿片类药物和兴奋剂的共同使用，以及 治疗在共同使用动态方面的作用对于持续预防用药过量至关重要。 然而，我们对阿片类药物和兴奋剂的模式和轨迹的了解存在重大差距。 用途及其在过量用药中的作用。迫切需要表征多物质的纵向性质 社区样本中的使用、治疗利用和过量。本次活动的总体目标是 该提案旨在进一步了解阿片类药物/兴奋剂使用的长期和短期模式， 检查阿片类药物/兴奋剂的共同使用与药物滥用治疗之间的纵向关系 随着时间的推移，非致命和致命的药物过量情况，以便为治疗和药物过量预防服务提供信息。我们 提出以下三个具体目标： 1) 描述阿片类药物和兴奋剂共同使用的长期模式 并检查共同使用轨迹、药物使用治疗、药物过量和死亡率之间的关系； 2) 检查阿片类药物和兴奋剂同时使用的实时短期模式和转变及其影响 与物质使用治疗和用药过量有关； 3) 评估机会和准备情况 扩大和加强不同程度人群的治疗和药物过量相关服务能力 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 30 多年的行为、 来自超过 5,000 名艾滋病毒注射者的实验室和临床数据 静脉内经验（ALIVE）队列研究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。补充了新招募的兴奋剂阿片类药物非注射队列 （SONIC），我们将对两个样本进行新的生态瞬时评估，以检查微观模式 使用并采用最先进的机器学习方法来识别模式及其与 在这个以社区为基础的样本中，随着时间的推移，治疗和过量用药的风险很高。定性 与利益相关者和具有不同阿片类药物/兴奋剂共同使用模式的人一起进行的研究将突出差距和 服务系统内的挑战，并确定具体的实施战略，以提高能力 解决异质并发阿片类药物/兴奋剂使用及相关需求。这项研究的结果将 提供证据来指导干预措施和政策，以改善使用多种药物的人的结果 旨在减少美国合成阿片类药物过量死亡的物质。