Vancouver Drug Users Study: Evaluating the Natural History of Injection Drug Use

温哥华吸毒者研究：评估注射吸毒的自然史

• 批准号: 9002025
• 负责人: Thomas Kerr
• 金额: $ 103.25万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-01 至 2019-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9002025
• 关键词: AIDS/HIV problem; Acute; Address; Adult; Area; Basic Science; Behavioral; Bioinformatics; Biological; British Columbia; Canada; Caring; Cessation of life; Cities; Cohort Studies; Crack Cocaine; Data; Development; Drug resistance; Drug usage; Drug user; Enrollment; Environment; Environmental Risk Factor; Epidemic; Ethnography; Evaluation; Event; Evolution; Funding; Genetic; Growth; HIV; HIV Seropositivity; HIV risk; Healthcare; Heroin; Home environment; Illicit Drugs; Immunologics; Incidence; Individual; Infection; Injecting drug user; Injection of therapeutic agent; Insurance; Intervention; Investigation; Link; Marketing; Medical; Methamphetamine; Methods; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Natural History; North America; Overdose; Participant; Peer Review; Persons; Pharmaceutical Preparations; Phylogenetic Analysis; Province; Public Health; Publications; Randomized Controlled Trials; Recruitment Activity; Relapse; Research; Research Infrastructure; Research Personnel; Risk; Risk Behaviors; Running; Scheme; Shapes; Site; Specimen; Surveys; Testing; Time; Treatment outcome; Virus; Work; Youth; addiction; administrative database; adolescent drug use; base; career; clinical epidemiology; cohort; cost effectiveness; development policy; experience; global health; high risk; illicit drug use; injection drug use; innovation; mathematical model; member; methamphetamine use; mortality; multidisciplinary; non-drug; novel; prescription opiate; prescription opioid misuse; programs; public health relevance; repository; resistant strain; social; trafficking; transmission process; trend

 DESCRIPTION: This application proposes novel investigations of the natural history of injection drug use, from initiation to cessation or death, as well as studies of trends in morbidity and mortality. We propose to undertake this work in Vancouver, Canada, where the steady growth in prescription opiate (PO) misuse has become a growing concern. Accordingly, we also seek to evaluate the impact of PO misuse on the natural history of injection drug use in an environment with an active heroin market, including the impact of PO use on injecting initiation and cessation, HIV risk behavior and overdose. We also aim to characterize early injecting careers and to identify the individual, social-structural and environmental factors that shape injecting initiation, early cessation of injecting, sustained injecting, and HIV risk behavior. Focusing on established injectors, we further aim to describe the individual, social-structural and environmental factors that shape cessation of and relapse into injecting, and associated morbidity and mortality. Our project involves the creation of a unique cohort, the Vancouver Drug Users Study (V-DUS, n = 1800), which involves adults who inject drugs and non-injecting street-involved drug-using youth. Participants provide behavioral information and biological specimens for testing, repository, and use by our team and other NIDA investigators. Members of our multidisciplinary team have more than two decades of experience conducting NIDA-funded cohort-based research, most recently through studies of IDU participating in the Vancouver Injection Drug Users Study (VIDUS), which is one of the longest-standing IDU cohort studies in the world, and street-involved drug-using youth participating in the At- Risk Youth Study (ARYS). In order to take advantage of considerable efficiencies, both academic and financial, we propose merging the ARYS and VIDUS cohorts into the Vancouver Drug Users Study (V-DUS), enabling a critical additional five years of investigation into the natural history f injection drug use. Vancouver is ideally suited for the proposed study for several reasons. The city was home to one of the most explosive HIV epidemics ever documented among IDU, and Vancouver is a port of entry for illicit drugs and is now experiencing a PO misuse epidemic. Further, under the province of British Columbia's universal healthcare plan, we are able to link cohort data to various administrative databases, permitting assessments of barriers to care that are free of the confounding effects of medical insurance schemes, and our established multidisciplinary team and other NIDA investigators use our cohort platform to undertake diverse work in the areas of clinical epidemiology, social, spatial, and basic science, as well as modeling and cost-effectiveness studies. Lastly, Vancouver has been the site of the development of a range of innovative programs for IDU and therefore we plan to use this cohort infrastructure to build on our track record of evaluating highly innovative programs for IDU, as well as other naturally occurring events. Through this work, we aim to address several urgent global health challenges and inform the development of policies and interventions that seek to address illicit drug use.

 描述：这项申请提出了对注射药物使用的自然历史进行新的调查，从开始到停止或死亡，以及对发病率和死亡率趋势的研究。我们建议在加拿大温哥华开展这项工作，在那里，处方阿片滥用(PO)滥用的稳步增长已成为一个日益令人担忧的问题。因此，我们还试图评估在海洛因市场活跃的环境中，PO滥用对注射毒品使用自然历史的影响，包括PO使用对注射开始和停止、HIV危险行为和过量使用的影响。我们还旨在确定早期注射职业的特征，并确定影响注射开始、早期停止注射、持续注射和艾滋病毒风险行为的个人、社会结构和环境因素。聚焦于已建立的注射器，我们的进一步目标是描述影响停止注射和复发的个人、社会结构和环境因素，以及相关的发病率和死亡率。我们的项目涉及创建一个独特的队列，即温哥华药物使用者研究(V-DUS，n=1800)，其中包括注射毒品的成年人和非注射街头吸毒的青少年。参与者提供行为信息和生物标本，以供我们的团队和其他NIDA调查人员测试、存储和使用。我们的多学科团队成员拥有20多年开展NIDA资助的队列研究的经验，最近开展的研究包括注射吸毒者参与温哥华注射吸毒者研究(VIDUS)，这是世界上历史最悠久的注射吸毒者队列研究之一，以及街头吸毒青年参与高危青年研究(ARYS)。为了利用相当大的学术和经济效率，我们建议将ARYS和VIDUS两个队列合并到温哥华毒品使用者研究(V-DUS)中，从而能够对注射毒品使用的自然历史进行关键的额外五年的调查。温哥华非常适合这项拟议的研究，原因有几个。温哥华是有史以来有记录的注射吸毒者中最具爆炸性的艾滋病毒流行之一，温哥华是非法药物的入境口岸，现在正在经历PO滥用流行。此外，根据不列颠哥伦比亚省的全民医疗保健计划，我们能够将队列数据与各种行政数据库联系起来，允许对不受医疗保险计划混淆影响的护理障碍进行评估，我们现有的多学科团队和其他NIDA调查人员使用我们的队列平台在临床流行病学、社会、空间和基础科学领域以及建模方面开展各种工作 和成本效益研究。最后，温哥华一直是为IDU开发一系列创新计划的地点，因此我们计划利用这一队列基础设施来加强我们评估IDU高度创新计划以及其他自然发生的活动的记录。通过这项工作，我们的目标是应对几个紧迫的全球卫生挑战，并为寻求解决非法药物使用问题的政策和干预措施的制定提供信息。