Studying How State and Local Health Services Delivery Policies can Mitigate the Effects of Disasters on Drug Addiction Treatment and Overdose: A Mixed-Methods Study of COVID-19.

研究州和地方卫生服务提供政策如何减轻灾难对毒瘾治疗和药物过量的影响：COVID-19 的混合方法研究。

• 批准号: 10305182
• 负责人: Matthew Eisenberg
• 金额: $ 73.63万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10305182
• 关键词: American; Behavioral; COVID-19; COVID-19 pandemic; Case Study; Centers for Disease Control and Prevention (U.S.); Characteristics; Computers; Counseling; Data; Data Sources; Disasters; Dose; Drug Addiction; Drug usage; Epidemic; Event; Face; Future; Geographic state; Harm Reduction; Health Services; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Home; Individual; Internet; Interruption; Interview; Knowledge; Lead; Legal; Life; Medical; Methadone; Methods; Naloxone; Overdose; Perception; Persons; Pharmaceutical Preparations; Pharmacotherapy; Policies; Policy Developments; Public Health; Public Policy; Relapse; Risk Factors; Services; Source; Speed; Substance Use Disorder; System; Telephone; Time; United States; Vertebral column; Videoconferencing; addiction; administrative database; aged; authority; climate change; design; health care delivery; implementation outcomes; insight; interest; medical specialties; non-drug; opioid use disorder; overdose prevention; overdose risk; pandemic disease; prevent; prevention service; psychologic; response; rural counties; social; stressor; telehealth; treatment services

ABSTRACT Public health disasters and the drug addiction and overdose epidemic are among the foremost public health issues facing the United States. Disaster-related disruptions to drug addiction treatment and overdose prevention services can be life-threatening to people with drug addiction. Public policies form the backbone of disaster response by delineating what health systems can and cannot do in the midst and aftermath of disasters. There are several types of state health service delivery policies with the potential to enhance access to drug addiction treatment and prevent overdose during disasters e.g., state telehealth policies allowing addiction treatment services to be delivered by phone, as opposed to video conference (a policy that may benefit people with drug addiction who lack computer and/or high-speed internet access); state harm reduction policies loosening restrictions on naloxone distribution during disasters; and state policies waiving in-person methadone dosing requirements and allowing individuals with opioid use disorder to take home a 14-28 days' supply. The implementation and effects of these policies on addiction treatment and overdose in the disaster context have not been studied; we will fill this gap by studying these policies in the context of the COVID-19 pandemic. We propose a mixed-methods study using a concurrent-embedded design. In Aims 1-2, we will conduct a 50-state study using a difference-in-differences approach to examine the effects of the state health services delivery policies of interest on rates of drug addiction treatment and fatal and non-fatal drug overdose. Data sources for Aims 1-2 will include 50-state administrative databases capturing services delivered in the general medical sector (IQVIA LRx/Dx and United Healthcare) and specialty addiction treatment sector (TEDS), as well as CDC fatal drug overdose data. In Aim 3, we will conduct in-depth qualitative case studies of eight US states hard-hit by COVID-19, with embedded case studies of local public health and healthcare systems in urban and rural counties within those states. A strength of the proposed study is its use of a concurrent embedded mixed-methods strategy, where qualitative case studies (Aim 3) will answer questions not addressed by the primary quantitative method (Aims 1-2). Our study will yield actionable evidence to inform policy development and implementation to enhance continuity to addiction treatment and prevent drug overdose during future disasters.

摘要 公共卫生灾难以及吸毒成瘾和吸毒过量流行病是最严重的公共卫生问题之一， 美国面临的问题。与灾害有关的戒毒治疗中断和药物过量 预防服务可能危及吸毒成瘾者的生命。公共政策是 通过界定卫生系统在灾害期间和之后可以做什么和不能做什么来应对灾害， 灾害有几种类型的州保健服务提供政策有可能提高获得服务的机会 药物成瘾治疗和防止在灾难期间过量，国家远程医疗政策允许 通过电话提供成瘾治疗服务，而不是视频会议（这一政策可能 使缺乏电脑和/或高速互联网接入的吸毒成瘾者受益）; 政策放宽了对灾害期间纳洛酮分配的限制;国家政策放弃了亲自 美沙酮给药要求，并允许阿片类药物使用障碍的个人带回家14-28天 供应这些政策在灾难中对成瘾治疗和过量用药的实施情况和效果 我们将在COVID-19的背景下研究这些政策，以填补这一空白 流行病我们提出了一个混合方法的研究，使用并发嵌入式设计。在目标1-2中， 使用差异中的差异方法进行50个州的研究，以检查州健康的影响 关于戒毒治疗率以及致命和非致命药物过量的服务提供政策。 目标1-2的数据源将包括50个州的行政数据库，这些数据库记录了 普通医疗部门（IQVIA LRx/Dx和United Healthcare）和专业成瘾治疗部门 （TEDS），以及CDC致命药物过量数据。在目标3中，我们将进行深入的定性案例研究 美国八个受COVID-19影响严重的州，其中包括当地公共卫生和医疗保健的嵌入式案例研究 在这些国家的城市和农村县的系统。拟议研究的一个优点是它使用了一个 并行嵌入式混合方法策略，其中定性案例研究（目标3）将回答问题 主要定量方法未解决的问题（目标1-2）。我们的研究将提供可采取行动的证据， 为政策制定和执行提供信息，以加强戒毒治疗和预防吸毒连续性 在未来的灾难中。