Studying How State and Local Health Services Delivery Policies can Mitigate the Effects of Disasters on Drug Addiction Treatment and Overdose: A Mixed-Methods Study of COVID-19.

摘要 公共卫生灾难以及吸毒和吸毒过量流行是最重要的公共卫生 美国面临的问题。与灾害有关的药物成瘾治疗中断和过量用药 预防服务可能会危及吸毒者的生命。公共政策构成了 通过描述卫生系统在灾难期间和灾后可以和不能做什么来应对灾难 灾难。有几种类型的国家卫生服务提供政策有可能加强可获得性 药物成瘾治疗和防止灾害期间过量用药，例如，国家远程保健政策允许 上瘾治疗服务将通过电话提供，而不是视频会议(这项政策可能 使没有计算机和/或高速互联网接入的吸毒者受益)；减少国家危害 放松灾害期间纳洛酮发放限制的政策；以及国家政策免除面对面 美沙酮剂量要求和允许阿片类药物使用障碍患者带回家14-28天 供给。灾区戒毒、用药过量政策实施情况及效果 我们将在新冠肺炎的背景下研究这些政策，以填补这一空白 大流行。我们提出了一种使用并行嵌入设计的混合方法研究。在目标1-2中，我们将 使用差异法进行50个州的研究，以检查州健康的影响 服务提供政策--关于药物成瘾治疗以及致命性和非致命性药物过量的利息率。 AIMS 1-2的数据源将包括50个州的行政数据库，这些数据库捕获在 普通医疗部门(IQVIA LRx/Dx和United Healthcare)和特殊成瘾治疗部门 (Teds)，以及疾控中心致命的药物过量数据。在目标3中，我们将进行深入的定性案例研究 美国受新冠肺炎影响最严重的八个州，嵌入了当地公共卫生和医疗保健的案例研究 在这些州的城市和农村县的系统。拟议研究的一个优点是它使用了 并行嵌入式混合方法战略，其中定性案例研究(目标3)将回答问题 没有用主要的定量方法解决(目标1-2)。我们的研究将提供可行的证据 为政策制定和执行提供信息，以加强成瘾治疗和预防毒品的连续性 在未来的灾难中服药过量。

ABSTRACT Public health disasters and the drug addiction and overdose epidemic are among the foremost public health issues facing the United States. Disaster-related disruptions to drug addiction treatment and overdose prevention services can be life-threatening to people with drug addiction. Public policies form the backbone of disaster response by delineating what health systems can and cannot do in the midst and aftermath of disasters. There are several types of state health service delivery policies with the potential to enhance access to drug addiction treatment and prevent overdose during disasters e.g., state telehealth policies allowing addiction treatment services to be delivered by phone, as opposed to video conference (a policy that may benefit people with drug addiction who lack computer and/or high-speed internet access); state harm reduction policies loosening restrictions on naloxone distribution during disasters; and state policies waiving in-person methadone dosing requirements and allowing individuals with opioid use disorder to take home a 14-28 days' supply. The implementation and effects of these policies on addiction treatment and overdose in the disaster context have not been studied; we will fill this gap by studying these policies in the context of the COVID-19 pandemic. We propose a mixed-methods study using a concurrent-embedded design. In Aims 1-2, we will conduct a 50-state study using a difference-in-differences approach to examine the effects of the state health services delivery policies of interest on rates of drug addiction treatment and fatal and non-fatal drug overdose. Data sources for Aims 1-2 will include 50-state administrative databases capturing services delivered in the general medical sector (IQVIA LRx/Dx and United Healthcare) and specialty addiction treatment sector (TEDS), as well as CDC fatal drug overdose data. In Aim 3, we will conduct in-depth qualitative case studies of eight US states hard-hit by COVID-19, with embedded case studies of local public health and healthcare systems in urban and rural counties within those states. A strength of the proposed study is its use of a concurrent embedded mixed-methods strategy, where qualitative case studies (Aim 3) will answer questions not addressed by the primary quantitative method (Aims 1-2). Our study will yield actionable evidence to inform policy development and implementation to enhance continuity to addiction treatment and prevent drug overdose during future disasters.