Stimulant Overdose in the Medicaid Population: Who is at Risk, and When are They at Risk

在过去的20年里，美国毒品过量在美国的流行急剧增长，有超过7万种致命的药物 仅在2019年就服用过量。服药过量死亡人数的增加是美国人多年来寿命下降的主要原因 甚至在新冠肺炎大流行开始之前，人们就已经看到了这种预期。导致年增幅最大的药物 过量死亡是合成阿片类药物、可卡因和其他兴奋剂(主要是甲基苯丙胺)。承认…… 可卡因和其他兴奋剂在吸毒过量流行中发挥的作用越来越大，美国疾病控制和预防中心 疾病控制和预防中心(CDC)呼吁加强监测和循证预防和应对 解决涉及这些制剂的过量问题的战略。虽然兴奋剂的使用率和过量服药已有报道 根据人口统计、身心健康状况、残疾和其他因素的不同，以前的研究没有发现 关于人口统计、残疾和健康的社会决定因素的个人数据，以及细粒度的衡量标准 来自医疗保健利用记录，有关于社会剥夺的全面的地区级数据有待开发 有关兴奋剂过量的风险和保护因素的知识。此外，之前没有任何研究聚焦于兴奋剂。 医疗补助参与者服药过量，这是一个庞大的、脆弱的、服务不足的人群，其中一半与苯丙胺有关 住院治疗就会发生。本项目涉及RFA-CE-21-002的目标2：评估非法行为的风险和保护因素 兴奋剂的使用、使用障碍或过量用药可促进干预措施的发展或适应 战略。该研究将1)开发和验证使用两个人的水平特征(包括人口统计)的模型 特征、家庭收入、诊断、处方和医疗保健利用)和地区特征 (包括广泛的社会经济剥夺措施)在15岁和15岁以下的医疗补助参与者中识别 年龄较大，因服用过量可卡因或其他兴奋剂而在急诊科(ED)遇到的风险最高的人； 2)开发和验证模型，以在15岁及以上的医疗补助参与者中确定ED风险最高的人群 遇到兴奋剂过量，当他们处于最高风险时；以及3)在15岁和15岁以上的医疗补助参与者中 以上与兴奋剂过量的既往ED接触，以测量和识别风险和保护因素的比率 用于随后因兴奋剂和/或阿片类药物过量而发生的ED。结果将在至少两个方面有用 方式。首先，他们将提供关于个人层面和社会因素的概括性知识，这些因素容易患上或 防止兴奋剂过量。这样的病因就可以成为国家、州、 为县级和地方各级改善这些原因的影响，以及作为今后研究的基础，更好地 了解潜在的因果机制。其次，可以务实地使用结果来识别高风险 将稀缺资源用于以证据为基础的预防吸毒过量办法。

The US drug overdose epidemic in the has grown dramatically in the past twenty years, with more than 70,000 fatal drug overdoses in 2019 alone. This growth in overdose deaths is a major contributor to the multiyear decline in US life expectancy that was seen even before the COVID-19 pandemic began. The drugs responsible for the largest increases in overdose deaths are synthetic opioids, cocaine, and other stimulants (primarily methamphetamine). In recognition of the increasing role that cocaine and other stimulants are playing in the drug overdose epidemic, the US Centers for Disease Control and Prevention (CDC) has called for increased surveillance and evidence-based prevention and response strategies to address overdoses involving these agents. While rates of stimulant use and overdose have been reported vary by demographics, physical and mental health conditions, disability, and other factors, no prior research has linked individual-level data on demographics, disability, and social determinants of health together with granular measures derived from healthcare utilization records, with comprehensive, area-level data on social deprivation to develop knowledge about risk and protective factors for stimulant overdose. Further, no prior research has focused on stimulant overdose in Medicaid enrollees, a large, vulnerable, underserved population in whom half of all amphetamine-related hospitalizations occur. This project addresses Objective 2 of RFA-CE-21-002: to assess risk and protective factors for illicit stimulant use, use disorder, or overdose that can contribute to the development or adaptation of intervention strategies. The study will 1) develop and validate a model using both person-level characteristics (including demographic characteristics, household income, diagnoses, prescriptions, and healthcare utilization) and area-level characteristics (including a wide range of measures of socioeconomic deprivation) to identify, among Medicaid enrollees age 15 and older, who is at highest risk of an emergency department (ED) encounter for overdose from cocaine or other stimulants; 2) develop and validate a model to identify, among those Medicaid enrollees age 15 and older at highest risk of an ED encounter for stimulant overdose, when they are at highest risk; and 3) among those Medicaid enrollees age 15 and above with a prior ED encounter for stimulant overdose, to measure the rate of and identify risk and protective factors for a subsequent ED encounter for overdose from stimulants and/or opioids. The results will be useful in at least two ways. First, they will provide generalizable knowledge about the individual-level and social factors that predispose to or protect against stimulant overdose. Such etiologic factors can then be the targets of intervention at the national, state, county, and local levels to ameliorate the effects of these causes, as well serve as the basis of future research to better understand the underlying causal mechanisms. Second, the results can be used pragmatically to identify high-risk individuals for the purpose of targeting scarce resources for evidence-based approaches to overdose prevention.