An ethno-epidemiological study of the implementation and effectiveness of an innovative and comprehensive response to the opioid epidemic

项目摘要/摘要 北美的阿片类药物流行是发病率和死亡率的主要驱动因素，与阿片类药物有关的过量 成为意外死亡和注射阿片类药物导致艾滋病毒和丙型肝炎(丙型肝炎)爆发的主要原因。 到目前为止，还缺乏对个人和个人外对执行的影响的研究 以及全面和创新应对阿片类药物流行的有效性。因此，在那里 缺乏对如何优化应对阿片类药物流行的认识，以及 在减少阿片类药物相关危害方面最有效的干预措施组合。总部设在温哥华， 在加拿大，拟议的研究将采用创新的民族流行病学方法来探索：(1) 以阿片类药物为重点的创新性综合干预措施的实施及其对阿片类药物相关的影响 结果；(2)综合循证做法对阿片类药物使用管理的影响 (3)社会的、结构性的和 环境对循证治疗中获取和保留的影响，以及对 与阿片类药物相关的结果。作为北美对阿片类药物反应最全面的地点之一 温哥华是开展这项拟议研究的理想地点。温哥华已经实施了 目前正在考虑的以阿片类药物为重点的创新干预措施--但尚未推出-- 在美国和加拿大的其他地方，包括：监督注射服务；低门槛阿片类激动剂 治疗；阿片类药物维持治疗；以及芬太尼药物检查和监测服务。另外， 当地制定的管理OUD的临床实践指南(最近在JAMA上发表)正在进行中 在急诊、住院和社区护理环境中实施，同时对医疗保健进行其他更改 系统，包括系统地将以阿片类药物为重点的治疗和减少危害方案纳入 医院环境。拟议的研究将嵌套在不列颠哥伦比亚省的研究基础设施中 艾滋病毒/艾滋病英才中心，包括由NIDA资助的三项纵向队列研究，包括 使用阿片类药物的PWUD(艾滋病毒阴性和艾滋病毒阳性)和街头吸毒的青少年(SY)，并与 外部健康和空间数据。因此，这种方法提供了一个利用这些群体的“增值”机会。 开展流行病学和空间信息抽样和有针对性地招募PWUD和 SY和收集定性数据，这些数据可以通过基于队列的数据和外部数据进行三角测量。延伸我们的民族- 流行病学研究检查这种对阿片类药物流行的全面反应将导致更多 完全了解对阿片类药物重点干预的影响，而不是通过流行病学 一个人做研究。拟议的研究与NIDA战略计划(2016-2021年)保持一致，并将产生 这些证据对于优化和扩大应对阿片类药物流行的工作至关重要。

PROJECT SUMMARY/ABSTRACT North America’s opioid epidemic is a major driver of morbidity and mortality, with opioid-related overdoses becoming the leading cause of accidental death and opioid injecting driving HIV and hepatitis C (HCV) outbreaks. To date, there has been a lack of research into individual and extra-individual influences on the implementation and effectiveness of comprehensive and innovative responses to the opioid epidemic. As a consequence, there is a lack of understanding regarding how to optimize the response to the opioid epidemic, as well as the combination of interventions that are most effective in reducing opioid-related harms. Based in Vancouver, Canada, the proposed research will employ an innovative ethno-epidemiological approach to explore: (1) the implementation of innovative and comprehensive opioid-focused interventions and their impact on opioid-related outcomes; (2) the impact of the integration of evidence-based practices in the management of opioid use disorders (OUD) across the continuum of care on addiction treatment outcomes; and, (3) social, structural, and environmental influences on access to and retention in evidence-based treatment, and the onward impact on opioid-related outcomes. As the site of one of North America’s most comprehensive responses to the opioid epidemic, Vancouver is the ideal setting to undertake the proposed research. Vancouver has implemented innovative opioid-focused interventions that are currently being considered – but are not yet available – elsewhere in the US and Canada, including: supervised injection services; low-threshold opioid agonist therapies; opioid maintenance therapy; and, fentanyl-based drug checking and monitoring services. Additionally, locally-developed clinical practice guidelines for the management of OUD (recently profiled in JAMA) are being implemented across acute, residential, and community care settings alongside other changes to the healthcare system, including the systematic integration of opioid-focused treatment and harm reduction programming into hospital settings. The proposed study will be nested within the research infrastructure of the British Columbia Centre for Excellence in HIV/AIDS, which includes three NIDA-funded, longitudinal cohort studies that include opioid-using PWUD (HIV-negative and HIV-positive) and drug-using street-involved youth (SY) and are linked to external health and spatial data. Thus, this approach offers a ‘value-added’ opportunity to harness these cohort studies to undertake epidemiologically and spatially-informed sampling and targeted recruitment of PWUD and SY and collect qualitative data that can be triangulated with cohort-based and external data. Extending our ethno- epidemiological research to examine this comprehensive response to the opioid epidemic will result in a more complete understanding of influences on opioid-focused interventions than is possible through epidemiological research alone. The proposed research is aligned with the NIDA Strategic Plan (2016-2021), and will generate evidence that will be critical to informing the optimization and scale-up of the response to the opioid epidemic.