Integrating responses to stimulant overdose among post-overdose programs

项目概要/摘要 虽然芬太尼和芬太尼类似物是美国阿片类药物过量的主要原因，但可卡因和 其他兴奋剂，如甲基苯丙胺，越来越多地出现在阿片类药物和非阿片类药物过量用药中 死亡。这些与兴奋剂相关的过量死亡现在是“不断演变的过量流行病”或第四大流行病的核心 药物过量危机的浪潮。由于黑人、拉丁裔和原住民在医疗保健系统中面临着不平等， 获得物质使用治疗的机会较少，他们受到这种涉及兴奋剂的第四种药物的影响不成比例 波。此外，在青少年中，目前涉及多种物质的过量死亡人数比仅使用阿片类药物的人数还要多 死亡。服药过量后外展计划已成为针对服药过量的重要且日益增长的应对措施 通过及时跟进服药过量幸存者来减少死亡，并且通常由公众合作实施 健康和公共安全团队。随着人们逐渐认识到可卡因等兴奋剂的作用 甲基苯丙胺、过量服用预防方案需要调整和加强，以解决兴奋剂问题 使用、使用障碍和过量风险。有机会利用这些计划来开发和 引入兴奋剂使用的适应性措施，以提供减少风险的教育和兴奋剂相关的教育 过量预防和与治疗的联系。在此基础设施内工作，与现有的后期合作伙伴合作 药物过量计划中，我们建议开发一套策略工具包，以减少与兴奋剂相关的死亡。每一个 这些改编将专门针对有色人种（黑人、拉丁裔和原住民）进行定制 青春。我们的具体目标是：(1) 开发和实施过量用药后外展适应工具包 解决整体以及有色人种和青少年中兴奋剂使用和兴奋剂过量问题的方案； (2) 对解决计划中兴奋剂使用问题的调整进行过程评估； (3) 确定 适应工具包的有效性：(a) 增加与使用兴奋剂的人的接触，(b) 减少 兴奋剂风险行为，以及 (c) 增加整体和人群中兴奋剂使用障碍的治疗机会 有色人种和年轻人。马萨诸塞州提供了一个数据丰富的环境来确定后的影响 过量服用兴奋剂过量的外展活动。在基于社区的参与性研究原则的指导下，我们 将整合适应性创新来解决从马萨诸塞州项目中学到的兴奋剂并使用它 为兴奋剂过量预防的设计和传播提供指导和信息 全国各地的社区。拟议的研究将解决目标 1，如 资助机会通知。

Project Summary/Abstract While fentanyl and fentanyl analogues are the main drivers opioid overdoses in the United States, cocaine and other stimulants, like methamphetamine, are increasingly present in both opioid and non-opioid overdose deaths. These stimulant-involved overdose deaths are now central to the “evolving overdose epidemic” or 4th wave of the overdose crisis. As Black, Latinx, and Native people face inequities in the health care system and lower access to substance use treatment, they are disproportionately affected by this stimulant-involved 4th wave. In addition, among youth, there are now more polysubstance involved overdose deaths than opioid only deaths. Post-overdose outreach programs have emerged as an important and growing response to overdose deaths by providing timely follow-up to overdose survivors and are often collaboratively implemented by public health and public safety teams. With the emerging recognition of the role of stimulants, like cocaine and methamphetamine, overdose prevention programs warrant adaptation and enhancement to address stimulant use, use disorders, and overdose risks. There is an opportunity to leverage these programs to develop and introduce adaptations for stimulant use that will provide risk reduction education and stimulant-related overdose prevention and linkage to treatment. Working within this infrastructure to partner with existing post- overdose programs, we propose to develop a toolkit of strategies to reduce stimulant-involved deaths. Each of these adaptations will be tailored to specifically engage people of color (Black, Latinx, and Native people) and youth. Our specific aims are to: (1) develop and implement a toolkit of adaptations for post-overdose outreach programs to address stimulant use and stimulant overdose overall and among people of color and youth; (2) conduct a process evaluation of the adaptations to address stimulant use in programs; and (3) determine the effectiveness of the toolkit of adaptations to: (a) increase contact with people who use stimulants, (b) reduce stimulant risk behaviors, and (c) increase treatment access for stimulant use disorder overall and among people of color and youth. Massachusetts provides a data-rich environment to ascertain the impact of post- overdose outreach on stimulant overdose. Guided by principles of community-based participatory research, we will integrate adaptive innovations to address stimulants learned from Massachusetts programs and use this information to guide and inform the design and dissemination of stimulant overdose prevention in communities across the country. The proposed research will address Objective 1, as described in the Notice of Funding Opportunity.