A comparative evaluation of overdose prevention programs in New York City and Rhode Island

纽约市和罗德岛州药物过量预防计划的比较评估

• 批准号: 10629749
• 负责人: Magdalena Cerda
• 金额: $ 147.47万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10629749
• 关键词: Accident and Emergency department; Accidents; Acute; Address; Affect; Authorization documentation; Businesses; Censuses; Cities; Client; Clinic; Communities; Consumption; Control Groups; Cost Effectiveness Analysis; Cost Savings; Country; Criminal Justice; Data; Data Set; Data Sources; Disease; Drug usage; Drug user; Economic Conditions; Economics; Education; Effectiveness; Environment; Ethnography; Evaluation; Event; Evidence based treatment; Fatality rate; Future; HIV; Harm Reduction; Health; Health Priorities; Health Services; Healthcare; Hepatitis C; Hospitals; Human Resources; Individual; Infective endocarditis; International; Intervention; Interview; Legal; Link; Location; Measures; Medicaid; Medical; Methods; Modeling; Municipal Government; Needle Sharing; Needle-Exchange Programs; Neighborhoods; New York City; Noise; Outcome; Outcome Measure; Overdose; Participant; Persons; Pharmaceutical Preparations; Physical environment; Play; Police; Policies; Prevention program; Procedures; Program Effectiveness; Property; Prospective cohort; Public Health; Qualitative Methods; Records; Research; Rhode Island; Risk; Role; Safety; Service delivery model; Services; Shapes; Site; Skin Tissue; Social Identification; Social Policies; Social Work; Soft Tissue Infections; Statutes and Laws; Sterility; Substance Use Disorder; Supervision; System; Time; Training; United States; United States Dept. of Health and Human Services; authority; cohort; community center; community engaged research; comparative; cost; cost effectiveness; drug market; effectiveness study; ethnographic method; experience; improved; innovation; microcosting; models and simulation; mortality; multidisciplinary; novel; overdose death; overdose prevention; peer; programs; prospective; public health emergency; recovery services; referral services; response; social; treatment services

ABSTRACT More than one million people have died from accidental drug overdose in the United States (US) in the past twenty years. In response to this unabating crisis, New York City implemented the first two publicly recognized overdose prevention centers (OPCs) in the nation in November 2021. Rhode Island became the first state to authorize OPCs through state legislation and they are expected to open in late 2022. OPCs are community- based facilities that permit clients to consume pre-obtained controlled substances under the supervision of personnel who are trained to intervene in the event of an overdose. Staff at OPCs also provide safer drug consumption education, access to sterile drug use supplies, offer health and ancillary services, and provide referrals to other treatment, health, and recovery services. While research from other countries and from an unsanctioned site in the US suggest that OPCs produce individual health and community benefits, no evaluations exist of sanctioned OPCs in the US. The proposed study has extraordinarily high policy significance, as it will evaluate the public health, public safety, and community benefits—and potential unintended effects—of the first sanctioned OPCs in the US. We propose to conduct a rigorous, multi-site, multi-component evaluation of OPCs in New York City and Rhode Island in 2023-2027. At the individual level, we aim to evaluate whether a prospective cohort of 500 persons attending OPCs experience lower rates of overdose, other health problems, and emergency department use, and a higher rate of substance use disorder treatment initiation, compared to a cohort of 500 persons who do not attend OPCs (Aim 1). At the community level, we will examine whether neighborhoods surrounding the OPCs experience a greater change in overdose, measures of drug-related public disorder, and acute economic conditions following the opening of OPCs, compared to neighborhoods unexposed to OPCs (Aim 2). Third, we aim to delve into the role that the operational context, including neighborhood location, program models, and operating procedures, plays in shaping the effectiveness of OPCs using qualitative and ethnographic approaches (Aim 3). Finally, we will estimate additional costs and cost savings to the healthcare and criminal justice systems associated with OPC use, to support future cost-effectiveness analyses of OPCs (Aim 4). To accomplish these aims, we have assembled an internationally renowned investigative team and established strong, community-engaged research partnerships with harm reduction organizations in New York City and Rhode Island. As more jurisdictions throughout the US consider opening OPCs, findings from the proposed research will have critical implications for US drug policy. The study’s results will have powerful, lasting implications for communities that wish to offer OPCs, generate critical data to optimize their effectiveness, and provide models for sustainability and expansion of these interventions.

摘要 过去，美国有超过一百万人死于意外药物过量 二十年为了应对这一有增无减的危机，纽约市实施了前两项公开承认的 2021年11月在全国设立过量预防中心（OPC）。罗得岛成为第一个 通过州立法授权OPC，预计将于2022年底开放。OPCs是社区- 允许客户在监督下消费预先获得的受控物质的设施 接受过药物过量事件干预培训的人员。OPCs的工作人员还提供更安全的药物 消费教育，获得无菌药物使用用品，提供保健和辅助服务，并提供 转介到其他治疗、健康和康复服务机构。虽然来自其他国家和一个 美国一个未经批准的网站建议，OPC产生个人健康和社区利益，没有评估 在美国有受制裁的OPC。这项研究具有极高的政策意义，因为它将 评估公共卫生，公共安全和社区利益-以及第一个潜在的意外影响 在美国的OPCs我们建议对OPCs进行严格的、多地点的、多组分的评价 纽约市和罗得岛的人口增长率。在个人层面，我们的目标是评估一个 500人参加OPCs的前瞻性队列经历了较低的过量率，其他健康问题， 和急诊室使用，以及较高的物质使用障碍治疗开始率，相比之下， 500名没有参加OPC的人（目标1）。在社区层面，我们将审查是否 OPCs周围的社区在过量用药方面发生了更大的变化， 与未暴露的社区相比， OPCs（目标2）。第三，我们的目标是深入研究的作用，操作环境，包括邻里 位置、项目模型和操作程序，在塑造使用OPCs的有效性方面发挥作用 定性和人种学方法（目标3）。最后，我们将估算额外成本和成本节约， 与OPC使用相关的医疗保健和刑事司法系统，以支持未来的成本效益 OPCs分析（目标4）。为了实现这些目标，我们召集了一个国际知名的 调查小组，并建立了强大的，社区参与的研究伙伴关系，减少危害 在纽约市和罗得岛的组织。随着美国越来越多的司法管辖区考虑开放 OPCs，拟议研究的结果将对美国药物政策产生重要影响。这项研究的结果 将对希望提供OPC的社区产生强大而持久的影响， 这些措施的有效性，并为这些措施的可持续性和扩大提供了模式。