CDC supplement year 2

CDC 补充第 2 年

• 批准号: 10828080
• 负责人: Alex Francis Manini
• 金额: $ 50万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10828080
• 关键词: Accident and Emergency department; Address; Admission activity; Adverse effects; Adverse event; Affect; American; Biological Markers; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Chronology; Clinical; Clinical Data; Clinical Management; Collaborations; Commerce; Critical Care; Data; Diagnosis; Disease Outbreaks; Disparity; Dose; Drug abuse; Emergency Care; Emergency Department evaluation; Emergency Department patient; Emergency department visit; Enrollment; Epidemic; Epidemiology; Evaluation; Forensic Medicine; Health; Heroin; Hospitals; Incidence; Ingestion; Knowledge; Length of Stay; Liquid Chromatography; Mechanical ventilation; Medical; Molecular; Morphine; Naloxone; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Patient Self-Report; Patients; Pattern; Periodicals; Pharmaceutical Preparations; Poison; Population; Prevalence; Principal Investigator; Property; Prospective, cohort study; Public Health; Qualifying; Reporting; Research; Research Activity; Research Personnel; Resource Allocation; Resources; Risk Factors; Sampling; Severities; Standardization; System; Testing; Time; Time trend; Toxicology; Treatment Protocols; Visit; abuse liability; addiction; analytic epidemiology; clinical effect; clinical predictors; clinical risk; cohort; cost; design; drug of abuse; fentanyl analog; fentanyl overdose; heroin overdose; illicit opioid; improved; insight; multidisciplinary; novel; opioid epidemic; opioid overdose; opioid use; organ injury; overdose death; patient registry; prescription opioid; prospective; regional difference; screening; sedative; sex; stem; substance use; synthetic opioid; tandem mass spectrometry; time of flight mass spectrometry; trend; trend analysis

ABSTRACT AND PROJECT SUMMARY The purpose of this R01 proposal is to deepen our knowledge of the primary cause of drug overdose deaths in the U.S. today: novel psychoactive synthetic opioids, the majority of which are fentanyl analogues. Using a nationwide registry of patients who present to emergency departments, novel fentanyl analogue overdose will be studied in terms of its epidemiology, analytical confirmation, clinical risk factors, and treatment needs, by a uniquely qualified multidisciplinary team with an extensive track record of collaboration in the field. The scope of the U.S. opioid epidemic is broadening, with drug overdose deaths nearly tripling from 1999- 2015. For the first time ever, in 2015 U.S. drug overdose deaths surpassed 50,000 (52,404), of which 33,091 (63.1%) involved an opioid. Overdose deaths continued to increase in 2016 to 63,600. Opioid overdoses cost Americans $504 billion in 2015 (2.8% of gross domestic product), up from six times the prior estimates in 2013. There was a 27% increase in nationwide Emergency Department visits for opioid overdoses last year alone. Strategies to mitigate this trend by decreasing the availability and abuse potential of prescription opioids have been followed by an increase in illicit opioid use. While initially the predominance of illicit opioid overdoses were a result of heroin exposure, the changing face of global drug commerce introduced synthetic opioid fentanyl analogues into the drug supply, where they are now estimated to have surpassed heroin as the primary cause of drug overdose deaths. Using nearly 70 hospital centers nationwide with bedside evaluation of patients, over 10,000 overdose patients have been enrolled in the Principal Investigator’s prior study giving this proposal momentum and feasibility. Our specific aims are four-fold: (1) To derive and validate clinical predictors of adverse health consequences of fentanyl analogue overdose; (2) To confirm fentanyl analogue exposure via state-of-the-art toxicology testing; (3) To investigate treatment utilization, duration, and disparities for fentanyl analogue overdose; and (4) To assess epidemiology of analytically-confirmed fentanyl analogue overdose. To achieve these Specific Aims, we will prospectively enroll a national sampling of patients. We will implement the rapid dissemination of alerts and information to the public and public health entities on adverse effects of fentanyl analogues. At the completion of the proposed research, the field of drug abuse will be significantly advanced to the benefit of thousands of victims of the U.S. opioid epidemic.

摘要和项目摘要 本 R01 提案的目的是加深我们对药物过量死亡主要原因的了解 今日美国：新型精神活性合成阿片类药物，其中大部分是芬太尼类似物。使用 全国范围内到急诊科就诊的患者登记处发现，新型芬太尼类似物过量服用将 由流行病学、分析确认、临床危险因素和治疗需求等方面进行研究 独特的合格多学科团队，在该领域拥有广泛的合作记录。 美国阿片类药物流行的范围正在扩大，药物过量死亡人数比 1999 年几乎增加了两倍 2015 年。2015 年，美国药物过量死亡人数首次超过 50,000 人（52,404 人），其中 33,091 人 (63.1%) 涉及阿片类药物。 2016 年，服药过量死亡人数继续增加，达到 63,600 人。阿片类药物过量的费用 2015 年美国人的收入为 5,040 亿美元（占国内生产总值的 2.8%），比 2013 年之前估计的六倍高。 仅去年一年，全国范围内因阿片类药物过量而到急诊室就诊的人数就增加了 27%。 通过减少处方阿片类药物的供应和滥用潜力来缓解这一趋势的策略已经 随后非法阿片类药物的使用有所增加。虽然最初非法阿片类药物过量占主导地位 由于接触海洛因，全球毒品贸易的面貌发生了变化，引入了合成阿片类药物 芬太尼类似物进入毒品供应，目前估计它们已超过海洛因，成为 药物过量死亡的主要原因。 利用全国近70个医院中心对患者进行床边评估，超过10,000名过量用药患者 已参加首席研究员之前的研究，为该提案提供了动力和可行性。 我们的具体目标有四个：(1) 推导并验证不良健康后果的临床预测因素 芬太尼类似物过量； (2) 通过最先进的毒理学测试确认芬太尼类似物的暴露； (3) 调查芬太尼类似物过量的治疗利用率、持续时间和差异； (4) 至 评估经分析证实的芬太尼类似物过量的流行病学。 为了实现这些具体目标，我们将前瞻性地招募全国患者样本。我们将实施 向公众和公共卫生实体快速传播有关不良影响的警报和信息 芬太尼类似物。拟议研究完成后，药物滥用领域将得到显着改善 造福于美国阿片类药物流行病的数千名受害者。

项目成果

Naloxone Use in Novel Potent Opioid and Fentanyl Overdoses in Emergency Department Patients.

在急诊科患者中，纳洛酮在新型有效阿片类药物和芬太尼过量中使用。

• DOI: 10.1001/jamanetworkopen.2023.31264
• 发表时间: 2023-08-01
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Amaducci, Alexandra;Aldy, Kim;Campleman, Sharan L.;Li, Shao;Meyn, Alison;Abston, Stephanie;Culbreth, Rachel E.;Krotulski, Alex;Logan, Barry;Wax, Paul;Brent, Jeffrey;Manini, Alex F.
• 通讯作者: Manini, Alex F.

Identification of a novel opioid, N-piperidinyl etonitazene (etonitazepipne), in patients with suspected opioid overdose.

• DOI: 10.1080/15563650.2022.2084406
• 发表时间: 2022-09
• 期刊: CLINICAL TOXICOLOGY
• 影响因子: 3.3
• 作者: Calello, Diane P.;Aldy, Kim;Jefri, Mohamed;Nguyen, Tuyet-Anh T.;Krotulski, Alex;Logan, Barry;Brent, Jeffrey;Wax, Paul;Walton, Sara;Manini, Alex F.
• 通讯作者: Manini, Alex F.

Opioid Use Disorder and COVID-19: Biological Plausibility for Worsened Outcomes.

• DOI: 10.1080/10826084.2020.1791184
• 发表时间: 2020
• 期刊: Substance use & misuse
• 影响因子: 2
• 作者: Schimmel J;Manini AF
• 通讯作者: Manini AF

Notes from the Field: Illicit Benzodiazepines Detected in Patients Evaluated in Emergency Departments for Suspected Opioid Overdose - Four States, October 6, 2020-March 9, 2021.

• DOI: 10.15585/mmwr.mm7034a4
• 发表时间: 2021-08-27
• 期刊: MMWR. Morbidity and mortality weekly report
• 作者: Aldy K;Mustaquim D;Campleman S;Meyn A;Abston S;Krotulski A;Logan B;Gladden MR;Hughes A;Amaducci A;Shulman J;Schwarz E;Wax P;Brent J;Manini A;Toxicology Investigators Consortium Fentalog Study Group
• 通讯作者: Toxicology Investigators Consortium Fentalog Study Group