Evaluation of Drug Checking as a Novel Intervention to Address the Opioid Overdose Crisis Attributable to Fentanyl and its Analogues

项目摘要 该申请要求资助对一个省级药品检查项目进行严格的科学评估， 在加拿大，毒品检查是法律的。毒品检查-分析非法药物样本， 向吸毒者提供药物成分信息（PWUD）-是一项高度创新的公共服务， 健康干预，可以使PWUD获得关键信息，并可能有助于拯救生命的行为 变化鉴于北美历史上最严重的药物过量危机，这一点尤其重要。 有证据表明，芬太尼和芬太尼类似物越来越多地被发现作为街头阿片类药物的掺假物 毒品在非洲大陆大部分地区都有供应，也可能在兴奋剂和迷幻剂街头毒品供应中找到。 虽然在一些欧洲司法管辖区已经使用了各种药物检查技术来减少 使用非法娱乐性药物（例如，摇头丸，摇头丸）在电子舞曲现场，毒品检查的其他 街头毒品在北美仍处于萌芽状态，在美国大部分仍是非法的。 在不列颠哥伦比亚省，各级政府都支持毒品检查计划，作为其阿片类药物的一部分， 过量应急响应，并投资于药物检查的技术和运营资金 服务，包括快速护理点和基于实验室的确认测试。这表示 研究这种干预措施及其对阿片类药物过量风险的影响的重要机会。因此，这 申请旨在资助一项严格的科学评估，旨在评估和描述 各种药物市场参与者采用床旁药物检查技术的情况（例如，阿片类药物使用者，兴奋剂 吸毒者、毒贩）。它进一步旨在行为影响和过量风险降低实践（例如，使用较少） 与接收不同药物市场行为者之间的定量和定性药物检查结果有关。 最后，它旨在研究药物检查服务利用对非致命性和致命性过量事件的影响。 这个高度创新和重要的研究计划涉及使用三个互补的来源， 数据：1）基线调查表数据，其中记录了人口统计学、药物使用模式和 行为，社会结构和环境暴露; 2）使用街头毒品含量的纵向数据 护理点和既定的实验室技术，以及收到以下信息后的预期行为数据 药物检查结果;以及3）关于过量的详细纵向行政公共卫生数据 通过加拿大的全民医疗保健系统。总的来说，这些数据将被保密地链接 并用于评估如何将这些信息整合到成瘾治疗和药物使用集中， 公共卫生规划。调查阿片类药物危机的创新解决方案与NIDA的 计划强调对合成精神活性药物的研究，以及广泛的行为干预 NIH的HEAL和阿片类药物倡议确定的目标，其中包括致力于预防和 逆转药物过量

PROJECT SUMMARY This application requests funding for the rigorous scientific evaluation of a provincial drug checking program in a Canadian setting where drug checking is legal. Drug checking—the analysis of illicit drug samples and provision of drug composition information back to people who use drugs (PWUD)—is a highly innovative public health intervention that can equip PWUD with crucial information and potentially contribute to life-saving behavior change. This is particularly relevant in light of the most serious drug overdose crisis in North American history. Evidence indicates that fentanyl and fentanyl analogues are increasingly found as adulterants in the street opioid supply across much of the continent, and may also be found in the stimulant and psychedelic street drug supply. While various drug checking technologies have been used in some European jurisdictions to reduce the risks of using illicit recreational drugs (e.g., MDMA, ecstasy) in the electronic dance music scene, drug checking of other street drugs is still nascent in North America and remains largely illegal in the U.S. In the Canadian province of British Columbia, governments at all levels have supported drug checking programs as part of their opioid overdose emergency response and have invested in technology and operational funding for drug checking services, including both rapid point-of-care and laboratory-based confirmatory testing. This represents a significant opportunity to study this intervention and its impacts on opioid overdose risk. Accordingly, this application seeks to fund a rigorous scientific evaluation that aims to evaluate and describe the rate and patterns of uptake of point-of-care drug checking technologies by various drug market actors (e.g., opioid users, stimulant users, drug dealers). It further aims to behavioral impacts and overdose risk reduction practices (e.g., using less) associated with receipt of quantitative and qualitative drug checking results among different drug market actors. Lastly, it aims to examine the impact of drug checking service utilization on non-fatal and fatal overdose events. This highly innovative and significant program of research involves the use of three complementary sources of data: 1) baseline questionnaire data, which captures information on demographics, drug use patterns and behaviors, and social-structural and environmental exposures; 2) longitudinal data on street drug contents using point-of-care and established laboratory techniques as well as data on intended behaviors following receipt of drug checking results; and 3) detailed longitudinal administrative public health data available on overdose outcomes through Canada’s universal health care system. Collectively, these data will be confidentially linked and used to evaluate how such information can be integrated into addiction treatment and substance use focused public health programming. Investigating innovative solutions to the opioid crisis is perfectly aligned with NIDA’s plans to highlight research on synthetic psychoactive drugs, as well as with the broad behavioral intervention goals identified by NIH’s HEAL and Opioid Initiatives, which include research dedicated to preventing and reversing overdoses.