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

降低阿片类药物使用者因用药过量、艾滋病毒和丙型肝炎导致的发病率和死亡率

• 批准号: 9764327
• 负责人: Ronald Scott Braithwaite
• 金额: $ 67.05万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9764327
• 关键词: AIDS prevention; Accident and Emergency department; Advocate; Buprenorphine; C10; Cessation of life; Collaborations; Communities; Contracts; County; Domiciles; Drug Modelings; Education; Epidemic; Fentanyl; Funding; Future; HIV; HIV Infections; HIV/HCV; Hepatitis; Hepatitis C; Hepatitis C Therapy; Heroin; Homeless persons; Infection; Infection prevention; Infrastructure; Injecting drug user; Intervention; Law Enforcement; Life Expectancy; Link; Liver Failure; Malignant neoplasm of liver; Medical; Medical Care Costs; Mental Depression; Methadone; Modeling; Morbidity - disease rate; Naloxone; Naltrexone; Needle-Exchange Programs; Neuraxis; Opioid; Opioid Antagonist; Overdose; Persons; Pharmaceutical Preparations; Pharmacy Distributions; Pharmacy facility; Policies; Population; Prevention program; Quality-Adjusted Life Years; Reporting; Stigmatization; Syringes; Treatment Cost; United States; Virginia; base; cost; experience; hazard; heroin use; high risk; mortality; nonmedical use; opioid agonist therapy; opioid injection; opioid mortality; opioid overdose; opioid use; opioid use disorder; overdose death; overdose prevention; overdose risk; pre-exposure prophylaxis; prescription opioid misuse; prevent; programs; respiratory; screening; social; successful intervention

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.

摘要/摘要 美国正在经历一场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 再加上一种越来越容易获得和更便宜的替代品：海洛因加或不加混合芬太尼。 纳洛酮是一种有效且安全的阿片类拮抗剂，可逆转潜在的致命呼吸系统和/或中枢 阿片类药物过量导致的神经系统抑郁。而纳洛酮在降低糖尿病风险方面是有效的。 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使用的危险 注射毒品的人，因此正在注射或将来可能这样做的人都处于兴奋状态 感染艾滋病毒和丙型肝炎的风险将干预措施与纳洛酮的分发联系起来，例如医疗辅助 治疗阿片类药物使用障碍(如美沙酮或丁丙诺啡)、艾滋病毒暴露前预防(PREP)、 和丙型肝炎筛查，有可能预防新的感染及其后遗症，并避免昂贵的费用 治疗。然而，准备和丙型肝炎治疗的高昂成本放大了使用 这些干预措施取得了成功，具有良好的价值。为了系统地权衡这些权衡， 为了给未来的过量用药预防计划提供信息，我们试图使用决策分析模型来比较 将纳洛酮分配与医疗辅助治疗、艾滋病毒预防和丙型肝炎联系起来的替代策略 放映。因此，我们的目标是比较治疗OUD和预防过量使用HIV的替代方案 感染和丙型肝炎病毒感染，比较预期寿命、质量调整后的预期寿命(QALY)和价值。我们的 提案扩展了我们与CT DPH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基础上的政策选择，特别是OEND、注射器更换方案 (9月)(如果适用)和MAT的设置。我们分别分析了针对用户的策略 阿片类药物(目标1)和针对过量反应者的战略(目标2)，因为这些战略往往明显 倡导、资助、管理和实施。