Reducing morbidity and mortality from overdose, HIV, and hepatitis C in opioid-using persons

摘要/总结 美国正在经历药物过量死亡的流行病，大多数可归因于某种类型的 阿片类药物由于处方阿片类药物的非医疗使用增加，阿片类药物过量死亡人数激增 再加上越来越容易获得和更便宜的替代品：海洛因与或不与芬太尼混合。 纳洛酮是一种有效和安全的阿片类拮抗剂，可逆转潜在致命的呼吸和/或中枢神经系统疾病。 阿片类药物过量导致的神经系统抑郁症。虽然纳洛酮能有效降低 过量死亡，它没有解决潜在的阿片类药物使用障碍或阿片类药物给药的危害 注射毒品的人，因此正在注射或将来可能注射毒品的人， 感染艾滋病毒和丙型肝炎的风险。将干预措施与纳洛酮分配联系起来，例如医疗辅助 治疗阿片样物质使用障碍的疗法（例如，美沙酮或丁丙诺啡），HIV暴露前预防（PreP）， 和丙型肝炎筛查，有可能预防新的感染及其后遗症， 治疗。然而，PreP和丙型肝炎治疗的高成本放大了雇用的重要性。 这些干预措施取得了成功，并具有良好的价值。为了系统地权衡这些权衡， 为了告知未来的过量预防计划，我们寻求采用决策分析模型来比较 将纳洛酮分配与医学辅助治疗、HIV预防和HCV联系起来的替代策略 筛选因此，我们的目标比较了治疗OUD和预防药物过量、HIV 感染和HCV感染，以比较预期寿命、质量调整预期寿命（QALY）和价值。我们 该提案扩展了我们与CT DPH的富有成效的合作，并启动了与VA DPH的新合作， 强调建立在现有基础设施上的政策选择，特别是注射器交换计划 (SEP)如适用，以及MAT的设置。我们分别分析针对使用者的策略， 阿片类药物（目标1）和针对过量反应者的策略（目标2），因为这些策略通常明显 倡导、资助、管理和实施。

ABSTRACT/SUMMARY The United States is experiencing an epidemic of drug overdose deaths, most attributable to some type of opioid. Opioid overdose deaths are surging because of increasing non-medical use of prescription opioids combined with an increasingly available and cheaper alternative: heroin with or without admixed fentanyl. Naloxone is an effective and safe opioid antagonist that reverses the potentially fatal respiratory and/or central nervous system depression caused from opioid overdose. While naloxone is effective in reducing the risk of overdose death, it does not address the underlying opioid use disorder or the hazards of opioid administration by people who inject drugs, and therefore people who are injecting or who may do so in the future are at high risk of contracting HIV and hepatitis C. Linking interventions to naloxone distribution, such as medical assisted therapy to treat opioid use disorder (e.g., methadone or buprenorphine), HIV pre-exposure prophylaxis (PreP), and hepatitis C screening, has the potential to prevent new infections and their sequela and avoid costly treatments. However, the high cost of PreP and hepatitis C treatment magnifies the importance of employing these interventions successfully and with favorable value. In order to weigh these tradeoffs systematically and to inform future overdose prevention programs we seek to employ a decision analytic model to compare alternative strategies for linking naloxone distribution with medical assisted therapy, HIV prevention, and HCV screening. Accordingly, our Aims compare alternative scenarios for treating OUD and preventing overdose, HIV infection, and HCV infection, to compare life expectancy, quality-adjusted life expectancy (QALY), and value. Our proposal extends our fruitful collaboration with the CT DPH and initiates a new collaboration with the VA DPH, emphasizing policy options that build on existing infrastructure, in particular OEND, Syringe Exchange Programs (SEP) where applicable, and settings for MAT. We analyze separately strategies directed at persons who use opioids (Aim 1) and strategies directed at overdose responders (Aim 2) because these strategies are often distinctly advocated, funded, administered, and implemented.