Navigating the Fentanyl Age with Community Drug Checking

项目摘要 药物供应变化巨大，非法制造的芬太尼(IMF)及其类似物造成了致命的 吸毒者的环境(PWUD)。2020年，国际货币基金组织夺走了93,311人的生命，是潜在的驱动力 当前的危机。它的快速发作几乎没有时间进行紧急干预，它的存在是主导的 流通中的阿片类药物破坏了循证治疗。罗德岛(RI)是早期国际货币基金组织的所在地 破坏，许多关于IMF的流行病学调查的主题，也是Expanded的创新中心 获得救命的纳洛酮和阿片类药物使用障碍(MOUD)和结构，以更好地提供 他们。最近的两项创新即使在国际货币基金组织的地方性和新冠肺炎大流行的情况下也显示出了希望，因为 它们正面解决了非法药物供应：非传统的Moud诱导途径和社区药物 正在检查。但是，除非我们学会如何导航，否则治疗的成功可能会受到非法药物供应的破坏。 它。这样做的一个新方法是社区毒品检查。药物检查让我们深入了解 人们使用的药物，让PWUD参与相关的健康信息交换，并产生可以 通知治疗。将这些数据应用于流行病学研究，以帮助更好地了解暴露， 确定风险、测量后果并考虑其在临床环境中的作用，以告知治疗 没有经过检查。我们建议进行一项观察性研究，利用最近获得的设备和容量 开展药品检查、多个可链接的个级数据集、国家法律和公共部门的研究 卫生领导支持药品检查。与RFA一致，我们试图揭示 国际货币基金组织在药物供应方面的影响、治疗方案和正在进行的药物使用以及人们故意使用药物的风险 或在不知情的情况下使用多物质(专题2和4)。具体目标是：目标1)检查大脑的解剖 通过建立社区毒品检查队列(n=600)，了解如何：a)货币基金组织的存在； 阿片类药物供应中的形式(即粉末、假药)和效力影响持续使用和过量使用的风险；b) 国际货币基金组织在兴奋剂等非阿片类药物中的存在会影响使用、过量用药风险和临床健康严重程度 结果；以及c)使用药物检查影响对Moud的摄取。[UG3和UH3]。目标2)文件 临床医生对药物检查的认知及其经验、创新、障碍和促进者 在RI中诱导患者服用Moud，包括微剂量和大剂量。目的3)评估 社区毒品检查队列成员a)哪些毒品供应特征与正在进行的 药物使用、过量用药和兴趣；b)哪些药物供应因素影响诱发问题的发生率 例如使用行政数据在丁丙诺啡护理中迅速戒断和成功保留。[UH3] 调查结果将有助于为国际货币基金组织流行地区的毒品供应提供预防和干预方法， 确定社区药物检查的参与度和临床效用，并帮助确定影响因素 治疗经验较差，保留率较高。

Project Summary The drug supply is in enormous flux with illicitly manufactured fentanyl (IMF) and analogs creating a deadly environment for people who use drugs (PWUD). Claiming 93,311 lives in 2020, IMF is the underlying driver of the current crisis. Its fast onset leaves little time for emergency intervention and its presence as the dominant opioid in circulation undermines evidence-based treatments. Rhode Island (RI) is a site of early IMF devastation, subject of much epidemiologic investigation about IMF, and an innovation hub for expanded access to lifesaving naloxone and medications for opioid use disorder (MOUD) and structures to better provide them. Two recent innovations show promise even with IMF’s endemicity and the COVID-19 pandemic because they address the illicit drug supply head-on: non-traditional MOUD induction pathways and community drug checking. But treatment success may be undermined by the illicit drug supply unless we learn how to navigate it. One novel approach to doing so is with community drug checking. Drug checking gives insights into what drugs people use, engages PWUD in relevant exchange of health information, and generates data that could inform treatment. Application of these data for epidemiologic research to help better understand exposure, identify risk, measure consequence and consideration of their role in a clinical setting to inform treatment have not been examined. We propose an observational study that leverages recently acquired devices and capacities to carry out research on drug checking, multiple linkable individual level datasets, and state law and public health leadership supportive of drug checking. Consistent with the RFA, we seek to uncover how characteristics of IMF in the drug supply influence treatment regimens and ongoing drug use and risk in people intentionally or unwittingly using polysubstances (topics 2 and 4). Specific aims are to: Aim 1) Examine the anatomy of the illicit drug supply by establishing a community drug checking cohort (n=600) to learn how: a) IMF’s presence, form (i.e., powder, counterfeit pill), and potency in the opioid supply affect ongoing use and overdose risk; b) IMF’s presence in non-opioid drugs like stimulants affects use, overdose risk and clinical severity of health consequences; and c) use of drug checking affects uptake of MOUD. [UG3 and UH3]. Aim 2) Document clinicians’ perceptions about drug checking, and their experiences, innovations, barriers and facilitators of induction of patients onto MOUD, including micro- and macro-dosing, in RI. [UH3] Aim 3) Assess among community drug checking cohort members a) which drug supply characteristics are associated with ongoing drug use, overdose and MOUD interest; b) what drug supply factors impact incidence of induction problems like precipitated withdrawal and successful retention in buprenorphine care using administrative data. [UH3] Findings will help inform prevention and intervention approaches to the drug supply in IMF endemic areas, determine engagement in and clinical utility of community drug checking, and help identify factors influencing poor treatment experience and better retention.