Dealers, Detectives, and People Who Use Drugs: Triangulating Perspectives to Understand COVID-19’s Impact on the Rural Appalachian Drug Market and Mitigate Downstream Overdose Risk

经销商、侦探和吸毒者：从三角角度了解 COVID-19 对阿巴拉契亚农村毒品市场的影响并降低下游用药过量风险

• 批准号: 10678905
• 负责人: Rachel Vickers-Smith
• 金额: $ 19.08万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10678905
• 关键词: Address; Affect; Appalachian Region; Area; Attenuated; Attitude; COVID-19; COVID-19 impact; COVID-19 pandemic; Characteristics; Collaborations; Communities; Data; Detection; Disease Outbreaks; Drug usage; Drug user; Emergency medical service; Fentanyl; Fostering; Funding; Goals; Harm Reduction; Health; Individual; Intervention; Interview; Kentucky; Law Enforcement; Life; Marketing; Measures; Methods; Naloxone; Natural Disasters; Overdose; Participant; Persons; Pharmaceutical Preparations; Policies; Recommendation; Recording of previous events; Research; Research Infrastructure; Risk; Risk Factors; Rural; Rural Appalachia; Rural Population; Services; Social Distance; Time; Translating; United States Substance Abuse and Mental Health Services Administration; Work; acceptability and feasibility; analog; community partnership; community transmission; coronavirus disease; drug market; drug use vulnerability; experience; fentanyl overdose; fentanyl test; fentanyl use; high risk; improved; novel; opioid epidemic; overdose death; overdose risk; peer; post-COVID-19; resilience; response; scale up; stay-at-home order; substance use; test strip; tool

Abstract: From June 2019 to May 2020, the US saw the highest number of OD deaths ever recorded in a 12- month period, with a heightened increase from March-May 2020 when control measures were first implemented. This translated to a 30% increase in the number of overdose deaths from 2019 to 2020. Kentucky, an epicenter of the opioid epidemic, had a 56% increase in the number of overdose deaths over the same period: the second greatest increase nationwide, and the highest number of fatal overdoses the state has ever recorded. Various factors have likely played a role in this surge. For example, stay-at-home orders and social distancing practices may result in PWUD using drugs in isolation more often – a risk factor for fatal OD given the limit to bystanders’ ability to administer naloxone and/or call emergency services. Early indications from data on COVID have some positing that drug market changes may impact individual level vulnerability to OD. In Kentucky, there was a 102% increase in fentanyl-involved OD deaths from Jan-Sept 2020 compared to the same period in 2019, suggesting that an influx of fentanyl in the drug supply has driven the recent increase in ODs. In response to the urgent need for intervention, the goal of this proposal is to understand the changes in the illicit fentanyl market brought about by COVID and simultaneously work to identify harm reduction strategies to reduce PWUD vulnerability and foster resilience to these changes. This proposal is timely not only in that it responds to an urgent, COVID-related surge in fatal ODs, but also because it aligns with a period of mass scale-up of SAMHSA-funded fentanyl test strip (FTS) services in Kentucky. The proposed mixed-methods, community-engaged R21 study, led by a scientific team with extensive experience in rural substance use research, will yield urgently needed, local data on harm reduction strategies that could curb the historic spike in fentanyl-related ODs in rural Appalachia by achieving the following aims: Aim 1. Characterize COVID’s effect on the illicit fentanyl market and potential fentanyl-related harm reduction strategies (i.e., FTS) in Appalachian Kentucky through qualitative interviews with state and local law enforcement and local harm reduction staff. Aim 2. Identify individual-level characteristics of rural PWUD most vulnerable and resilient to pre-/post-COVID changes in fentanyl use and OD risk through an analysis of existing longitudinal data spanning the pre-/post-COVID period. Aim 3. Describe COVID’s impact on the local illicit fentanyl market and OD risk and explore attitudes toward potential harm reduction strategies (e.g., FTS, peer- and dealer-driven distribution of FTS) through qualitative interviews with people who sell drugs and PWUD identified as most vulnerable and most resilient to COVID-related changes in the Aim 2 analysis. Subaim 3a. Examine acceptability of an FTS intervention among Aim 3 participants using a small pilot with pre and 1-month post qualitative interviews.

摘要：从2019年6月到2020年5月，美国看到了有史以来最多的OD死亡人数12- 一个月期，从2020年3月至5月第一次进行控制措施的时间增长 实施的。从2019年到2020年，过量死亡人数增加了30％。 肯塔基州是阿片类药物流行的中心，过量死亡人数增加了56％ 同一时期：全国第二大增长，致命数量最高的州次数过量 曾经记录过。各种因素可能在这一激增中发挥了作用。例如，在家订单 社交距离的做法可能会导致使用更常见的药物 - 致命的危险因素 OD限制了旁观者管理纳洛酮和/或致电紧急服务的能力。早期的 关于COVID数据的迹象表明，药物市场的变化可能会影响个人水平 OD的脆弱性。在肯塔基州，Jan-nept的芬太尼涉及OD死亡人数增加了102％ 2020年与2019年同期相比，这表明芬太尼在药物供应中的影响已驱动 OD的最近增加。为了应对迫切需要干预，该提议的目的是 了解Covid带来的非法芬太尼市场的变化，并只是为 确定减少危害的策略，以减少流向脆弱性并促进这些变化的韧性。这 提案不仅是及时的，因为它响应了致命的ODS的紧急，相关的激增，而且还因为 它与肯塔基州SAMHSA资助的芬太尼测试条（FTS）服务的大规模扩展相符。这 拟议的混合方法，由社区参与的R21研究，由一支具有丰富经验的科学团队领导 在粗糙的物质使用研究中，将急需急需有关减少伤害策略的当地数据 通过实现以下目的：AIM 1，遏制芬太尼相关的ODS中与芬太尼相关的ODS的历史尖峰。 表征了Covid对非法芬太尼市场的影响和潜在的芬太尼相关伤害的影响 阿巴拉契亚肯塔基州的策略（即FTS）通过对州和地方法律的定性采访 执法和当地危害人员。目标2。确定大多数农村pwud的个人水平特征 通过分析 现有的纵向数据涵盖了循环前/循环后期。目标3。描述Covid对当地的影响 非法芬太尼市场和OD风险，并探索有关减少危害策略的广告（例如，FTS， 通过与出售毒品的人进行定性访谈，并以同行和经销商为驱动的FTS） 在AIM 2分析中，PWUD被确定为最脆弱，最能力对共价相关的变化。 Subaim 3a。检查AIM 3参与者使用小型飞行员的AIM 3中FTS干预的可接受性 和1个月的定性访谈。