Evaluation of a novel intervention to prevent polysubstance overdoses involving illicit stimulants

项目摘要 在美国，涉及非法兴奋剂的过量使用正在增加。这些过量中的许多涉及 芬太尼，可在使用者不知情的情况下添加到非法兴奋剂中。鉴于……的效力 芬太尼及其在非法药物供应中的普及性，任何减少过量死亡的有意义的努力 涉及非法兴奋剂的药物也必须涉及芬太尼。芬太尼快速试纸，旨在测试 尿样中存在芬太尼和一些芬太尼类似物，越来越多的人在标签外使用 使用药物在消费前对非法药物进行芬太尼测试的人。这会提醒用户他们可能 希望执行减少过量风险的行为(例如，使用较少的药物)。然而，由于紧急情况 关于这一减少危害战略的性质，同行评议发表的关于这一主题的研究非常有限。这个 拟议的研究针对NOFO的第一个目标，并将测试一项干预措施，以防止 有非法兴奋剂使用史的毒品法庭客户的高危人群。干预措施包括1) 芬太尼试纸教育和分配(FTSED)和2)阿片类药物过量教育和纳洛酮 通过俄亥俄州的毒品法庭进行分销(OEND)。这项研究的长期目标是减少 俄亥俄州和全国与服药过量相关的发病率和死亡率。本研究的研究目标为：1) 确定通过毒品法庭现场提供FTSED和OEND的可接受性和可行性(流程 评估-特定目标1)；和2)评估提供FTSED与OEND相结合的影响 与使用非法兴奋剂或包括非法兴奋剂在内的多种物质的毒品法庭客户相比 仅提供OEND(结果评估特定目标2和3)。使用双臂组随机试验 设计时，我们将通过测试以下具体目标来回答研究目标：1)确定 与现场提供FTSED和OEND相关的感知可接受性、障碍和促进因素 向使用非法兴奋剂或包括非法兴奋剂在内的多种物质的客户提供药品法院；2)测试 假设有非法兴奋剂使用史的个人在现场接受FTSED和OEND药物治疗 法院将提高关于如何测试药物芬太尼和策略的知识和自我效能 与那些只接受OEND的人相比，他们降低了过量服药的风险；3)测试以下假设 有非法兴奋剂使用史的个人在毒品法庭现场获得FTSED和OEND将获得 与非法兴奋剂或涉及非法的多物质使用有关的非致命性和致命性过量服药率较低 比那些只接受OEND的人更有刺激性。鉴于芬太尼在非法药物供应中的普遍性， 即使个人的首选药物是非法兴奋剂，也有可能遇到芬太尼和/或芬太尼。 类似物。我们将评估整合的可行性、可接受性以及相关的益处和危害 FTSED进入毒品法庭项目，在一个涉及兴奋剂的过量服药率很高的州。

Project Summary Overdoses involving illicit stimulants are increasing in the United States (US). Many of these overdoses involve fentanyl, which may be added to illicit stimulants with or without the user’s knowledge. Given the potency of fentanyl and its pervasiveness in the illicit drug supply, any meaningful efforts to reduce overdose deaths involving illicit stimulants must also address fentanyl. Rapid fentanyl test strips, designed to test for the presence of fentanyl and some fentanyl analogs in urine samples, are increasingly being used off-label by people who use drugs to test illicit drugs for fentanyl before consumption. This alerts the user that they may wish to perform overdose risk reduction behaviors (e.g., using less of the drug). However, due to the emergent nature of this harm reduction strategy, peer-reviewed published research on this topic is very limited. The proposed study addresses Objective #1 of the NOFO and will test an intervention to prevent overdoses among a high-risk population of drug court clients with a history of illicit stimulant use. The intervention consists of 1) fentanyl test strip education and distribution (FTSED) and 2) opioid overdose education and naloxone distribution (OEND) through drug courts in Ohio. The long-term goal of this research is the reduction of overdose-related morbidity and mortality in Ohio and nationally. The research objectives of this study are: 1) Determine the acceptability and feasibility of providing FTSED and OEND on-site through drug courts (process evaluation – Specific Aim #1); and 2) Evaluate the impact of providing FTSED in combination with OEND to drug court clients who use illicit stimulants or polysubstances including illicit stimulants, compared with providing OEND alone (outcome evaluation – Specific Aims #2 & #3). Using a two-arm group randomized trial design, we will answer the research objectives by testing the following specific aims: 1) Determine the perceived acceptability, barriers, and facilitating factors associated with providing FTSED and OEND on-site in drug courts to clients who use illicit stimulants or polysubstances including illicit stimulants; 2) Test the hypothesis that individuals with a history of illicit stimulant use who receive FTSED and OEND on-site in drug courts will have improved knowledge and self-efficacy regarding how to test drugs for fentanyl and strategies for reducing their risk of an overdose compared to those who receive OEND only; 3) Test the hypothesis that individuals with a history of illicit stimulant use who receive FTSED and OEND on-site in drug courts will have lower non-fatal and fatal overdose rates associated with illicit stimulants or polysubstance use involving illicit stimulants than those who receive OEND only. Given the pervasiveness of fentanyl in the illicit drug supply, even individuals whose preferred drugs are illicit stimulants are likely to encounter fentanyl and/or fentanyl analogues. We will evaluate the feasibility, acceptability, and associated benefits and harms of integrating FTSED into drug court programs in a state with high rates of overdoses involving stimulants.