Predicting medical consequences of novel fentanyl analog overdose using the Toxicology Investigators Consortium (TOXIC)

使用毒理学研究联盟 (TOXIC) 预测新型芬太尼类似物过量的医疗后果

• 批准号: 10160611
• 负责人: Alex Francis Manini
• 金额: $ 14.94万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10160611
• 关键词: 2019-nCoV; Accident and Emergency department; Address; Adult; Adverse effects; Affect; Alcohol or Other Drugs use; American; Azithromycin; Biological Assay; COVID-19; COVID-19 pandemic; Cardiovascular system; Cessation of life; Clinical; Clinical Data; Collaborations; Commerce; Critical Care; Critical Illness; Data; Data Collection; Databases; Disease Outcome; Drug Interactions; Drug abuse; Emergency Care; Emergency Department patient; Emergency department visit; Enrollment; Environmental Risk Factor; Epidemiology; Evaluation; Event; Failure; Fentanyl; Grant; Health; Heroin; Home environment; Homelessness; Hospitals; Hydroxychloroquine; Immune; Imprisonment; Incidence; Individual; Infection; Infrastructure; Inpatients; Institution; Knowledge; Laboratories; Lung; Marijuana; Measures; Mechanical ventilation; Medical; Medical Records; Methadone; Molecular; Naloxone; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Patients; Pharmaceutical Preparations; Population; Prevalence; Principal Investigator; Prospective cohort; Public Health; Registries; Research; Research Activity; Research Personnel; Resources; Rest; Risk; Risk Factors; Severities; Substance Use Disorder; Substance of Abuse; Swab; Time; Toxicology; United States; Vent; Ventilator; Ventilatory Depression; analog; base; clinical risk; cohort; cost; data streams; experience; illicit opioid; improved; interest; multidisciplinary; novel; opioid epidemic; opioid overdose; opioid use; opioid use disorder; opioid user; overdose death; pandemic disease; patient registry; population health; prescription opioid; prospective; respiratory; response; social factors; statistics; stem; synthetic opioid; transmission process; trend; vaping

ABSTRACT AND PROJECT SUMMARY The purpose of this R01 proposal is to deepen our knowledge of the primary cause of drug overdose deaths in the U.S. today: novel psychoactive synthetic opioids, the majority of which are fentanyl analogues. Using a multicenter network, patients who present to emergency departments with novel fentanyl analogue overdose will be studied in terms of analytical confirmation, clinical risk factors, treatment needs, and regional trends. The PI has assembled a multidisciplinary team with an extensive track record of collaboration in the field. The scope of the U.S. opioid epidemic is broadening, with drug overdose deaths nearly tripling from 1999-2015. For the first time ever, in 2015 U.S. drug overdose deaths surpassed 50,000 (52,404), of which 33,091 (63.1%) involved an opioid. Overdose deaths continued to increase in 2016 to 63,600. Opioid overdoses cost Americans $504 billion in 2015 (2.8% of gross domestic product), up from six times the prior estimates in 2013. There was a 27% increase in nationwide Emergency Department visits for opioid overdoses last year alone. Strategies to mitigate this trend by decreasing the availability and abuse potential of prescription opioids have been followed by an increase in illicit opioid use. While initially the predominance of illicit opioid overdoses were a result of heroin exposure, the changing face of global drug commerce introduced synthetic opioid fentanyl analogues into the drug supply, where they are now estimated to have surpassed heroin as the primary cause of drug overdose deaths. Using nearly 70 hospital centers nationwide with bedside evaluation of patients, over 10,000 overdose patients have been enrolled in the Principal Investigator’s prior study giving this proposal momentum and feasibility. Our specific aims are three-fold: (1) To confirm and characterize fentanyl analogue overdoses in a new prospective cohort; (2) To evaluate sequelae, treatment needs, and resource utilization following fentanyl analogue overdoses; and (3) To trend and geolocate analytically confirmed fentanyl analogue overdoses across a multicenter network. To achieve these Specific Aims, we will prospectively enroll a new multicenter cohort of patients. We will implement the rapid dissemination of alerts and information to the public and public health entities on adverse effects of fentanyl analogues. At the completion of the proposed research, the field of drug abuse will be significantly advanced to allow prediction of medical consequences for thousands of victims of the U.S. opioid epidemic.

摘要和项目总结 本R 01提案的目的是加深我们对药物过量死亡的主要原因的了解， 今日美国：新型精神活性合成阿片类药物，其中大多数是芬太尼类似物。使用 多中心网络，因新型芬太尼类似物过量前往急诊室的患者 将在分析确认、临床风险因素、治疗需求和区域趋势方面进行研究。 PI组建了一个多学科团队，在该领域有着广泛的合作记录。 美国阿片类药物流行的范围正在扩大，药物过量死亡人数几乎是 1999-2015. 2015年，美国药物过量死亡人数首次超过50，000（52，404），其中 33，091例（63.1%）涉及阿片类药物。2016年药物过量死亡人数继续增加至63，600人。阿片 2015年，过量用药给美国人造成了5040亿美元的损失（占国内生产总值的2.8%），比2015年增加了6倍。 2013年估计。全国范围内因阿片类药物过量而前往急诊室的人数增加了27% 去年一年。通过减少药物的供应和滥用可能性来减缓这一趋势的战略 处方类阿片之后，非法类阿片使用有所增加。虽然最初的优势， 非法阿片类药物过量是接触海洛因的结果，全球毒品贸易的变化介绍了 合成阿片类芬太尼类似物进入药物供应，据估计， 海洛因是吸毒过量死亡的主要原因。 利用全国近70个医院中心对患者进行床边评估， 患者已入组主要研究者的既往研究，从而推动了该提案， 可行性 我们的具体目标有三个方面：（1）确认和表征芬太尼类似物过量的新方法， 前瞻性队列研究;（2）评价芬太尼治疗后的后遗症、治疗需求和资源利用 类似物过量;和（3）趋势和地理定位分析证实的芬太尼类似物过量 通过多中心网络。 为了实现这些特定目标，我们将前瞻性招募一个新的多中心患者队列。我们 将向公众和公共卫生实体快速传播警报和信息， 芬太尼类似物的副作用。在拟议的研究完成后，药物滥用领域将 它将大大提高，以预测美国数千名受害者的医疗后果。 阿片类药物流行病