Off-label Use of Rapid Response Fentanyl Test Strips as an Opioid Overdose Prevention Strategy

项目概要/摘要 描述：参见说明。这必须包含一个适合向公众传播的拟议活动的摘要（没有 专有/机密信息）。它应该是一个独立的项目描述，并包含一个目标和方法的声明， 就业。它应该对在相同或相关领域工作的其他人提供信息。不要超过所提供的空间。 我们提出了一个混合方法的研究，以探讨积极和消极的后果芬太尼测试 注射毒品者使用试纸（FTS）（PWID）。涉及非法制造的芬太尼的过量（OD）死亡 (IMF)2013-2016年，美国增长了540%，2016-2017年又增长了45.2%，国际货币基金组织- 2016年，死亡人数首次超过海洛因和处方阿片类药物死亡人数。快速 货币基金组织在非法药物市场的扩散导致风险环境加剧，其特点是 纯度和效力不明的掺假产品。虽然纳洛酮是一种经证实的二级预防OD 在国际货币基金组织充斥毒品市场之后，我们现在通过防止吸毒过量受害者死亡的战略， 需要主要的OD预防策略，以防止OD的发生摆在首位。在过去的3 多年来，美国和加拿大的社区组织已经开始分发FTS作为主要的 预防吸毒过量战略。FTS与床旁妊娠试验的相似之处在于药物溶液后的妊娠试验 与试纸接触时，试纸显示一条或两条红线，表示阳性或阴性 结果FTS的成本约为1美元，使其成为OD预防计划的合理成本。知之甚少 使用FTS的PWID的积极和消极后果。该申请提出了一个严格的 PWID的前瞻性研究，以Zinberg的药物，设置和设置模型为指导。具体目标如下： 目的1：评估与FTS使用相关的积极行为健康后果， 北卡罗来纳州（N=350）和西弗吉尼亚州（N=350）的PWID。目的2：评估消极行为健康 在北卡罗来纳州和西弗吉尼亚州的一个PWID队列中，与FTS使用相关的后果。目标3： 对PWID（n=100）进行定性访谈，以了解药物、设置和设置因素如何影响 FTS的使用、购药和用药行为以及OD风险。为达致这些目标，我们会招聘一名 来自两个注射器服务项目地点（格林斯伯勒，NC和Morgantown，WV）的700个PWID样本。西 2017年，弗吉尼亚州的芬太尼OD死亡率在美国最高，北卡罗来纳州排名第二 芬太尼OD死亡率增幅最高（2016-2017年）。对于目标1和2，我们将收集定量数据 与基线、6个月和12个月时的FTS使用和药物、设定和设定因素有关。目标3： 将有目的地从定量队列中抽取100个PWID的子集。该研究由Multiple 主要研究人员乔恩·齐贝尔（Jon Zibbell）是国家药物滥用研究所（NIDA）资助的医学人类学家 有多年研究IMF的经验，还有Judith Feinberg，一种由NIDA资助的传染病， 具有研究综合服务提供系统经验的医生。该团队还包括Alex Kral， NIDA资助的以社区为基础的研究流行病学家，具有多年研究OD的经验， Stephen Tueller，NIH资助的统计学家。拟议研究的结果将有助于科学 关于阿片类药物OD预防的文献，并帮助为应对OD危机的当前预防策略提供信息。

PROJECT SUMMARY/ABSTRACT DESCRIPTION: See instructions. This must contain a summary of the proposed activity suitable for dissemination to the public (no proprietary/confidential information). It should be a self-contained description of the project and contain a statement of objectives and methods to be employed. It should be informative to other persons working in the same or related fields. DO NOT EXCEED THE SPACE PROVIDED. We propose a mixed-methods study to investigate the positive and negative consequences of fentanyl test strip (FTS) use by people who inject drugs (PWID). Overdose (OD) deaths involving illicitly made fentanyl (IMF) increased 540% in the United States from 2013–2016 and another 45.2% from 2016–2017, with IMF- involved deaths outnumbering heroin and prescription opioid deaths for the first time in 2016. The rapid proliferation of IMF in the illicit drug market has led to a heightened risk environment characterized by adulterated products of unknown purity and potency. While naloxone is a proven secondary OD prevention strategy by preventing fatalities among OD victims, in the wake of the IMF flooding the drug markets, we now need primary OD prevention strategies to prevent ODs from occurring in the first place. Over the past 3 years, community-based organizations in the U.S. and Canada have started to distribute FTS as a primary OD prevention strategy. FTS are comparable to point-of-care pregnancy tests in that after a drug solution comes into contact with the test strip, the strip displays one or two red lines, denoting positive or negative results. FTS cost about $1, making them a reasonable cost to OD prevention programs. Little is known about the positive and negative consequences of PWID using FTS. This application proposes a rigorous prospective study of PWID, guided by Zinberg’s Drug, Set, and Setting model. The specific aims are as follows: Aim 1: To assess positive behavioral health consequences associated with FTS use in a cohort of PWID in North Carolina (N=350) and West Virginia (N=350). Aim 2: To assess negative behavioral health consequences associated with FTS use in a cohort of PWID in North Carolina and West Virginia. Aim 3: To conduct qualitative interviews with PWID (n=100) to learn how Drug, Set, and Setting factors influence the use of FTS, drug purchasing and drug use behavior, and OD risk. To achieve these aims, we will recruit a sample of 700 PWID from two syringe service program sites: Greensboro, NC, and Morgantown, WV. West Virginia had the highest fentanyl OD death rate in the U.S. in 2017, and North Carolina had the second highest rate increase (2016–2017) in fentanyl OD deaths. For Aims 1 and 2, we will collect quantitative data pertaining to FTS use and drug, set, and setting factors at baseline, 6 months, and 12 months. For Aim 3, we will purposively sample a subset of 100 PWID from the quantitative cohort. The study is led by Multiple Principal Investigators, Jon Zibbell, a National Institute of Drug Abuse (NIDA)-funded medical anthropologist with many years of experience studying IMF, and Judith Feinberg, an NIDA-funded infectious disease physician with experience studying integrated service delivery systems. The team also includes Alex Kral, an NIDA-funded community-based research epidemiologist with many years of experience studying OD, and Stephen Tueller, an NIH-funded statistician. Findings from the proposed study will contribute to the scientific literature on opioid OD prevention and help inform current prevention strategies in response to the OD crisis.