Methamphetamine injection, associated health risk, and causes of overdose deaths.

项目摘要/摘要 我们建议调查注射甲基苯丙胺的动机，与其共同使用的关联 芬太尼和传染病风险，以及#年甲基苯丙胺过量死亡的潜在原因 旧金山(旧金山)和奥克兰(橡树)，加利福尼亚州。所有主要指标都表明， 甲基苯丙胺在美国的使用。从2015年到2018年，160万美国成年人报告过去- 每年使用甲基苯丙胺，其中22%报告注射甲基苯丙胺。当美国经历了 20世纪90年代末和2000年代甲基苯丙胺使用量的大幅增加，使用冰毒的动机和 随之而来的健康风险得到了很好的描述。然而，将非法制造的芬太尼引入药物 在过去的5年里，美国的市场已经显著地改变了现在冰毒的背景 使用。被称为“第四波阿片类药物流行”的是芬太尼和安慰剂联合使用的激增。 冰毒。坊间证据表明，芬太尼及其类似物非常有效，以至于人们 动机是联合使用甲基苯丙胺来克服使用芬太尼带来的重度镇静。 因此，我们对注射甲基苯丙胺的动机的理解必须在 这一新的背景。我们还需要更新我们对注射甲基苯丙胺的人的理解 在芬太尼时代，感染传染病的风险增加。而20世纪90年代和21世纪初的数据 显示共用注射器和性风险增加，目前尚不清楚这些是否会持续到新一轮 甲基苯丙胺注射剂及其与芬太尼合用。而不是阿片类药物过量死亡，这是 由呼吸抑制引起，我们对中国潜在死因的分布知之甚少 冰毒过量。美国唯一的流行病学研究表明，最常见的额外 死亡原因为脑出血(15%)和心脏疾病(6%)。这项研究早在联合- 芬太尼的使用，此后过量死亡人数激增。如果我们不知道为什么使用 甲基苯丙胺正在死亡，我们无法解决如何防止这种死亡的问题。目标1：描述 注射冰毒的动机。目的2：评估甲基苯丙胺与 芬太尼联合使用有传染病危险行为。目标3：确定潜在的 死因包括急性甲基苯丙胺中毒的人的死因。要实现 目标1和目标2，我们将招募800名以社区为基础的队列，他们使用有针对性的药物注射 SF和OAK的采样方法。我们将以基线和每月进行调查，为期6个月，使用7- 日时间线回访法。为了达到目标3，我们将确定所有过量服药的死因 通过查阅旧金山法医记录，2016年至2024年与冰毒有关的死亡人数 (估计N=500)。这些发现将为政策制定者、卫生部门、 以及与注射甲基苯丙胺的人合作的机构，以减轻随之而来的健康风险。

PROJECT SUMMARY/ABSTRACT We propose to investigate motivations for methamphetamine injection, associations of its co-use with fentanyl and infectious disease risk, and the underlying causes of death for methamphetamine overdose in San Francisco (SF) and Oakland (OAK), California. All major indicators point to a steep increase in methamphetamine use in the United States (US). From 2015 to 2018, 1.6 million US adults reported past- year methamphetamine use, of which 22% reported injecting methamphetamine. When the US experienced a large increase in methamphetamine use in the late 1990s and 2000s, the motivations for its use and attendant health risks were well characterized. However, the introduction of illicitly made fentanyl into drug markets in the US in the past 5 years has significantly altered the context in which methamphetamine is now used. What is being termed the “fourth wave of the opioid epidemic” is a surge in co-use of fentanyl and methamphetamine. Anecdotal evidence suggests that fentanyl and its analogs are so potent that people are motivated to co-use methamphetamine to overcome the heavy sedation that accompanies fentanyl use. Consequently, our understanding of the motivations for methamphetamine injection must be updated within this new context. We also need to update our understanding of how people who inject methamphetamine are at increased risk for infectious diseases during the fentanyl era. While the data from the 1990s and 2000s showed increased syringe sharing and sexual risks, it is unclear whether these persist in the new wave of methamphetamine injection and its co-use with fentanyl. As opposed to opioid overdose deaths, which are caused by respiratory depression, we know little about the distribution of underlying causes of death in methamphetamine overdoses. The only US epidemiological study showed that the most common additional causes of death were cerebral hemorrhage (15%) and cardiac conditions (6%). That study predated the co- use of fentanyl, after which overdose deaths have surged. If we do not know why people who use methamphetamine are dying, we cannot address how to prevent such deaths. Aim 1: To characterize motivations for methamphetamine injection. Aim 2: To assess the association of methamphetamine and fentanyl co-use with infectious disease risk behaviors. Aim 3: To determine the distribution of underlying causes of death among people whose cause of death includes acute methamphetamine toxicity. To achieve Aims 1 and 2, we will recruit a community-based cohort of 800 people who inject drugs using targeted sampling methods in SF and OAK. We will conduct surveys at baseline and monthly for 6 months, using 7- day timeline follow-back methods. To achieve Aim 3, we will determine cause of death of all overdose fatalities involving methamphetamine from 2016 to 2024 by reviewing medical examiner records in SF (estimated N=500). Findings will provide rigorous empirical evidence to policymakers, health departments, and agencies working with people who inject methamphetamine to mitigate attendant health risks.