Developing the evidence base for overdose policies: a multilevel analysis of NHBS

翻译后摘要：过量（OD）流行病是21世纪美国最严重的危机之一，注射的人 毒品（PWID）是其震中。ODs是PWID的主要死亡原因，PWID的数量是 升中国然而，我们经常错过为PWID干预措施建立证据基础的机会： 许多州正在制定法律，以打击阿片类药物的流行（处方药监测计划 [PDMP]，纳洛酮准入法，好撒玛利亚人法），以及一个高影响力的研究机构，现在 分析这些法律和其他卫生政策（医疗补助扩展，医疗海事法[MML]）， 影响普通人群的ODs。然而，迄今为止，这项研究忽略了PWID，一个非常脆弱的 这些法律可能会影响到与普通民众不同的人群。 越来越多的关于地方特征的研究（例如，社区贫困率）和ODs也 被忽视的PWID然而，基于地点的暴露的范围和影响可能因PWID而异。 NIDA优先考虑产生科学证据来指导政策。当决策者面对这场健康危机时， 然而，他们正在起草法律，缺乏关于其对PWID可能影响的证据。同样，缺乏 关于地方特征对PWID中OD的影响的科学证据切断了整个竞技场， 基于地点的干预措施，已被证明对PWID中的其他健康结果有效的干预措施。 在风险环境模型和公共卫生法学研究原则的指导下， 国家艾滋病毒行为监测（NHBS）在美国20多个大都市统计区约38，800名PWID的数据 （MSAs）在2009年，2012年，2015年和2018年与州法律和MSAs特征的现有数据， 县和这些PWID居住的邮政编码。这个丰富的数据库将使我们能够实现三个目标：目标1： 应用多层次方法分析PDMP、Medicaid Expansion和MML与自我 PWID中报告的OD、OD风险因素和（PDMP和Medicaid）物质使用障碍治疗。 我们将分析关系是否因（a）PWID种族/民族、性别、年龄和HIV状态而异;以及（B） PWID居住的邮政编码和县的特征。目标二。运用多层次方法分析 纳洛酮使用法和好撒玛利亚人法与纳洛酮使用和旁观者的关系 对ODs的反应，并了解关系是否因（a）PWID种族/民族、性别、年龄和艾滋病毒状况而异;以及 (b)PWID居住的邮政编码和县的特征。目标3。使用多层次方法进行分析 PWID邮政编码、县和MSA的特征与自我报告的OD、OD风险因素的关系， 和物质使用障碍治疗;并测试关系是否因PWID种族/种族、性别、年龄和 艾滋病毒感染状况。每个目标还将使用多层次结构方程模型来分析联系暴露的途径 到结果。研究结果将提供一些初步证据，以帮助制定法律和基于地方的干预， 艾滋病毒/艾滋病是艾滋病流行中心不断增长和被忽视的人口。

Abstract: The overdose (OD) epidemic is one of the worst crises of the 21st century US, and people who inject drugs (PWID) are at its epicenter. ODs are the leading cause of death for PWID, and the number of PWID is rising. We are, though, routinely missing opportunities to develop the evidence base for interventions for PWID:  Many states are enacting laws to combat the opioid epidemic (Prescription Drug Monitoring Programs [PDMPs], Naloxone Access Laws, Good Samaritan Laws), and a high-impact body of research is now analyzing how these laws, and other health policies (Medicaid Expansion, Medical Marijuana Laws [MMLs]), affect ODs in the general population. To date, though, this research has ignored PWID, a highly vulnerable population that may respond differently to these laws than members of the general population.  The growing body of research on place characteristics (e.g., neighborhood poverty rates) and ODs has also neglected PWID. The range and impact of place-based exposures, however, may differ for PWID. NIDA prioritizes generating scientific evidence to guide policy. As policymakers confront this health crisis, however, they are crafting laws with scant evidence about their possible effects on PWID. Likewise, the lack of scientific evidence about the effects of place characteristics on ODs among PWID cuts off whole arenas of place-based interventions, interventions that have proven effective for other health outcomes among PWID. Guided by the Risk Environment Model and Public Health Law Research principles, we will integrate CDC National HIV Behavioral Surveillance (NHBS) data on ~38,800 PWID in 20+ US metropolitan statistical areas (MSAs) in 2009, 2012, 2015, and 2018 with existing data on state laws and on characteristics of the MSAs, counties, and ZIP codes where these PWID live. This rich database will allow us to achieve three aims: Aim 1: Apply multilevel methods to analyze relationships of PDMPs, Medicaid Expansion, and MMLs to self- reported ODs, OD risk factors, and (for PDMPs and Medicaid) substance use disorder treatment among PWID. We will analyze if relationships vary by (a) PWID race/ethnicity, gender, age, and HIV status; and (b) characteristics of the ZIP codes and counties where PWID live. Aim 2. Apply multilevel methods to analyze relationships of Naloxone Access Laws and Good Samaritan Laws to naloxone access and bystander responses to ODs, and learn if relationships vary by (a) PWID race/ethnicity, gender, age, and HIV status; and (b) characteristics of ZIP codes and counties where PWID live. Aim 3. Use multilevel methods to analyze relationships of characteristics of PWID ZIP codes, counties, and MSAs to self-reported ODs, OD risk factors, and substance use disorder treatment; and test if relationships vary by PWID race/ethnicity, gender, age, and HIV status. Each Aim will also use multilevel structural equation models to analyze pathways linking exposures to outcomes. Results will provide some of the first evidence to help develop laws and place-based interven- tions to combat ODs among PWID, a growing and neglected population at the epicenter of the OD epidemic.