Leveraging Psychological Autopsies to Accelerate Research into Stimulant Overdose Mortality

项目摘要/摘要 药物中毒(又称“过量”)是一个复杂的概念，特别是对兴奋剂而言。而阿片类药物过量是 兴奋剂过量一般由呼吸抑制引起，是多方面的。非致命事件很可能发生 由心脏和精神疾病引起的。然而，人们对致命事件的了解较少。心理学 尸检已被证明在了解阿片类药物过量死亡、识别 过量服药的许多关键因素至今仍在推动过量服药预防工作，我们建议 利用这一机制加快我们对兴奋剂过量死亡率的理解和反应。为 例如，心脏病在兴奋剂过量中更常见。 比海洛因过量或上吊自杀更容易死亡。然而，大多数兴奋剂过量死亡 缺乏额外的医学解释。通过心理尸检，我们可以利用的不仅仅是医学上的 审查员数据，还有医疗记录和线人面谈，以确定心脏病和投诉 死亡的前奏。这一方法响应了《框架协议》的目标2，还考虑到了详细的 了解服药过量(即自杀)的意图，以及有机会确定 芬太尼在兴奋剂/芬太尼过量事件中的使用意向性。我们将确定100种兴奋剂过量 死者(分为可卡因、甲基苯丙胺和可卡因或甲基苯丙胺加芬太尼)， 进行举报人面谈(包括量表和定性数据)，并从尸检中收集数据 调查(例如，生命记录、毒物学、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名在世的使用 兴奋剂(一半吸食大麻，一半吸食可卡因)，以探索复原力的要素和降低风险的策略。

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.