Leveraging Psychological Autopsies to Accelerate Research into Stimulant Overdose Mortality

项目概要/摘要 药物中毒（又名“过量”）是一个复杂的结构，特别是兴奋剂。虽然阿片类药物过量是 一般由呼吸抑制引起，兴奋剂过量是多方面的。可能发生非致死性事件 心脏病和精神病引起的然而，对致死性事件的了解较少。心理 尸检已被证明在了解阿片类药物过量死亡方面非常有价值， 许多过量的关键因素，仍然推动过量预防工作今天，我们建议， 利用这种机制来加速我们对兴奋剂过量死亡的理解和反应。为 例如，心脏病以前被确定为在兴奋剂过量中更常见， 比海洛因过量或上吊自杀更严重然而，大多数兴奋剂过量死亡 缺乏额外的医学解释通过心理解剖，我们不仅可以利用医疗手段 检查员数据，而且医疗记录和线人访谈，以确定心脏病和投诉 在死亡之前这一方法响应了RFA的目标2，还允许详细 了解过量用药的意图（即自杀），以及有机会确定 芬太尼在兴奋剂/芬太尼过量事件中使用的意向性。我们将确定100兴奋剂过量 死者（分为可卡因、甲基苯丙胺和可卡因或甲基苯丙胺与芬太尼）， 进行线人访谈（包括量表和定性数据），并从事后调查中收集数据 调查（例如，生命记录、毒理学、尸检、病例叙述、死亡现场照片）和医疗 记录抽象随后，我们将对40-60名使用 研究人员还将研究兴奋剂（一半甲基苯丙胺，一半可卡因）的使用情况，以探讨复原力和减少风险战略的要素。

Project Summary/Abstract Drug poisoning (aka “overdose”) is a complex construct, particularly for stimulants. While opioid overdose is generally caused by respiratory depression, stimulant overdose is multi-faceted. Non-fatal events are likely driven by cardiac and psychiatric complaints. However, fatal events are less well understood. Psychological autopsies have been shown to be immensely valuable in understanding opioid overdose deaths, identifying many of the key elements of overdose that still drive overdose prevention efforts today, and we propose to leverage that mechanism to accelerate our understanding of and response to stimulant overdose mortality. For example, cardiac disease has previously been identified as more common among stimulant overdose decedents than heroin overdose or suicide-by-hanging. However, the majority of stimulant overdose deaths lack an additional medical explanation. With psychological autopsies, we can leverage not just medical examiner data, but also medical records and informant interviews to identify cardiac disease and complaints antecedent to death. This approach, responsive to Objective 2 of the RFA, also allows for a detailed understanding of the intent of overdose (i.e. suicidality), as well as an opportunity to determine the intentionality of fentanyl use in stimulant/fentanyl overdose events. We will identify 100 stimulant overdose decedents (divided among cocaine, methamphetamine, and cocaine or methamphetamine with fentanyl), conduct informant interviews (including scales and qualitative data), and gather data from the post mortem investigation (e.g., vital records, toxicology, autopsy, case narrative, death scene photographs) and medical record abstraction. Subsequently, we will conduct qualitative interviews with 40-60 living people who use stimulants (half MA, half cocaine) to explore elements of resilience and risk reduction strategies.