Ethno-epidemiology of HCV, HIV and Overdose associated with Drug Markets and Drug Tourism

与毒品市场和毒品旅游相关的丙型肝炎病毒、艾滋病毒和药物过量的民族流行病学

• 批准号: 10833944
• 负责人: STEFFANIE A. STRATHDEE
• 金额: $ 14.74万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10833944
• 关键词: Address; Adult; Affect; Anxiety; Border Community; Buprenorphine; California; Cause of Death; Cessation of life; Cities; Client; Communities; Country; Dose; Dose Limiting; Drug Contamination; Drug Metabolic Detoxication; Drug usage; Drug user; Enrollment; Epidemiology; Federal Government; Feeling suicidal; Fentanyl; Funding; HIV; HIV Seronegativity; HIV Seropositivity; Hepatitis C virus; Heroin; Infiltration; Infrastructure; Injecting drug user; International Agencies; Interruption; Intervention; Interview; Medicine; Mental Depression; Mental Health; Methadone; Mexican; Mexico; Modeling; Municipalities; National Institute of Drug Abuse; Opiate Addiction; Opioid; Outcome; Overdose; Parents; Participant; Pattern; Persons; Pharmaceutical Preparations; Pharmacotherapy; Pharmacy facility; Plants; Policy Maker; Prevalence; Quality Control; Relapse; Reporting; Running; Sampling; Time; Travel; Visit; World Health Organization; anxiety symptoms; cohort; depressive symptoms; drug market; drug relapse; experience; high risk; manufacture; manufacturing facility; methadone clinic/center; methadone treatment; mortality; opioid mortality; opioid use; opioid use disorder; overdose death; overdose risk; prospective; recruit; substance use; suicidal; suicidal morbidity; suicide mortality; suicide rate

In April 2023, Mexico’s federal government closed the country’s only methadone manufacturing plant following concerns about quality control. In Mexican-U.S. border cities, such as Tijuana, where the prevalence of opioid use disorder (OUD) is among the country’s highest, the city’s four methadone clinics are turning new clients away, and for existing clients are limiting doses or not dosing altogether. Although there are no accurate estimates of the number of persons with OUD in Mexico, there were ~1000 adults receiving methadone in Tijuana alone at the time of the plant closure. Few empirical studies have been conducted on the impact of methadone dispensing interruptions but these have focused almost entirely on methadone prescribers, rather than people with OUD and have only examined short-term effects. We propose to leverage our existing cohort infrastructure in Tijuana to meet these Aims: 1) To qualitatively explore the experiences of adults in Tijuana receiving methadone for the treatment of OUD following the closure of Mexico’s only methadone manufacturing plant. 2) To prospectively characterize the impact of the closure of Mexico’s only methadone manufacturing plant on rates of drug use relapse, overdose (OD), suicidality, anxiety, depression and mortality among adults with OUD in Tijuana. Specifically, we will compare PWUD who have had their methadone treatment interrupted vs. those who have not and those who have never or not recently received methadone treatment. 3) To estimate the number of ODs and deaths caused by the closure of Mexico’s only methadone manufacturing plant among PWUD in Tijuana over the first month and first year after the closure using dynamic modeling. We hypothesize that PWUD with methadone treatment interruptions will have higher rates of drug relapse, OD, depression, anxiety, suicidality and death. We will re-open recruitment in the parent study to enroll 200 PWUD in Tijuana who were recently receiving methadone treatment, and compare outcomes to the existing cohort (N=250 for a total of N=450). Participants will undergo quantitative interviews every 6 months over 18 months. A subset will be purposively sampled for prospective qualitative interviews. Dynamic modeling will be used to estimate the impact of treatment interruptions on rates of overdose and mortality, and micro- and macro-level interventions that may be undertaken to ameliorate the crisis. Findings will be used to inform policymakers at the municipal, state and federal level in Mexico, as well the US and international agencies.

2023年4月，墨西哥联邦政府关闭了该国唯一的美沙酮制造厂， 关注质量控制。在墨西哥-美国边境城市，如蒂华纳，阿片类药物的流行率 使用障碍（OUD）是该国最高的，该市的四个美沙酮诊所正在转向新的客户 对于现有的客户，他们正在限制剂量或完全不给药。虽然没有准确的 据估计，墨西哥OUD患者人数约为1000人， 在工厂关闭的时候。很少有实证研究已经进行的影响， 美沙酮配药中断，但这些几乎完全集中在美沙酮处方，而不是 比OUD患者多，并且只检查了短期影响。我们建议利用现有的队列 基础设施，以满足这些目标：1）定性探讨成人在天津的经验 在墨西哥唯一的美沙酮关闭后接受美沙酮治疗OUD 制造工厂。2)前瞻性地描述关闭墨西哥唯一的美沙酮的影响 制造厂对吸毒复吸率、过量（OD）、自杀、焦虑、抑郁和死亡率的影响 在天津的成人OUD患者中。具体来说，我们将比较使用美沙酮的PWUD 治疗中断vs.未接受和从未接受或最近未接受美沙酮治疗的患者 治疗3)以估计墨西哥唯一的美沙酮关闭造成的吸毒过量和死亡人数 在关闭后的第一个月和第一年， 建模我们假设，美沙酮治疗中断的PWUD将有更高的药物滥用率， 复发、OD、抑郁、焦虑、自杀和死亡。我们将在母研究中重新开放招募， 在天津招募200名最近接受美沙酮治疗的PWUD，并将结果与 现有队列（N=250，总计N=450）。参与者将每6个月进行一次量化面试 超过18个月一个子集将有目的地抽样进行前瞻性定性访谈。动力学建模 将用于估计治疗中断对用药过量率和死亡率的影响， 以及为缓解危机而可能采取的宏观干预措施。调查结果将用于告知 墨西哥市、州和联邦一级的决策者以及美国和国际机构。