The short and long-term dynamics of opioid/stimulant use: Mixed methods to informoverdose prevention and treatment related to polysubstance use

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Project summary In response to NOT-DA-23-011, this administrative supplement will expand the scope of the parent project (R01DA057673, MPI: Genberg and German) on short and long-term effects of polysubstance use to incorporate collection of quantitative and qualitative data on criminal legal involvement. Specifically, this application will broaden and complement the skills of our investigative team to include researchers with expertise on characterizing the intersection of substance use and criminal legal involvement, with a focus on people who use drugs’ interaction with street-level police officers. The overall objective of this administrative supplement is to elucidate the relationship between polysubstance use and encounters with police and other elements of the criminal legal system in a community-recruited cohort of people who use drugs in Baltimore, MD. To date, most studies have only examined the association between polysubstance use and incarceration cross-sectionally, yet rigorous longitudinal data on the upstream drivers of incarceration, such as interactions with police, are lacking. Overcoming this knowledge gap is important as pre-arrest diversion is seen as a critical opportunity for police to link people who use drugs to community-based recovery services yet our understanding on police-PWUD interactions is limited with respect to polysubstance use. Thus, we intend to collect detailed quantitative and qualitative data on anticipated and realized experiences with street-level police (e.g. stopped, arrested, harassed) among PWUD by accomplishing the following specific aims to: 1) evaluate real-time associations between polysubstance use and the mediating role of social determinants (e.g. housing instability and employment status) on negative police encounters; and 2) characterize experiences, perceptions, and consequences of criminal legal involvement during polysubstance using episodes. We will accomplish Aim 1 by adding criminal legal involvement measures to ongoing data collection of ecological momentary assessments among 200 PWUD. To complement the quantitative results, we will conduct 20 in- depth interviews with PWUD who had recent encounters with street-level police to contextualize the findings in Aim 1. We will leverage findings from this supplement to inform an R34 preliminary effectiveness trial to pilot pre-arrest deflection to recovery support, MOUD, and wrap-around services for people with severe substance use disorder, including individuals who engage in polysubstance use.