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

甲基苯丙胺注射、相关健康风险以及过量死亡的原因。

• 批准号: 10708813
• 负责人: ALEXANDER H KRAL
• 金额: $ 54.21万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10708813
• 关键词: Acute; Address; Adult; Amphetamines; Back; California; Cardiac; Cause of Death; Cerebral hemisphere hemorrhage; Cessation of life; Chronic; Communicable Diseases; Communities; Data; Death Certificates; Disease Outbreaks; Drug usage; Environment; Epidemic; Epidemiologist; Fentanyl; Funding; HIV; HIV diagnosis; HIV/HCV; Health; Hepatitis C virus; Hospitalization; Illicit Drugs; Indiana; Injecting drug user; Injections; Link; Massachusetts; Medical Examiners; Mental Depression; Methamphetamine; Methamphetamine overdose; Methamphetamine use disorder; Methods; Motivation; National Institute of Drug Abuse; Needle Sharing; Overdose; Pain management; Performance; Persons; Pharmaceutical Preparations; Physicians; Policy Maker; Psychiatrist; Public Health; Publishing; Records; Reporting; Research Personnel; Risk; Risk Behaviors; Sampling; San Francisco; Sedation procedure; Sexually Transmitted Diseases; Shapes; Substance Use Disorder; Surveys; Toxic effect; Toxicology; United States; Update; Urine; Ventilatory Depression; Washington; Weight; West Virginia; analog; cohort; disorder prevention; disorder risk; drug market; epidemiology study; experience; fentanyl use; follow-up; methamphetamine use; mortality; opioid epidemic; opioid mortality; overdose death; pleasure; prevent; psychostimulant; public health intervention; recruit; risk sharing; screening; sexually transmitted virus; timeline

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.

项目总结/摘要 我们建议调查动机甲基苯丙胺注射，其共同使用的协会与 芬太尼和传染病的风险，以及甲基苯丙胺过量死亡的根本原因， 弗朗西斯科（SF）和奥克兰（OAK），加州。所有主要指标都表明， 甲基苯丙胺在美国（US）的使用。从2015年到2018年，有160万美国成年人报告说， 2010年，有22%的人报告注射甲基苯丙胺。当美国经历 1990年代末和2000年代，甲基苯丙胺的使用大量增加，其使用的动机， 伴随的健康风险得到了很好的描述。然而，由于药物的引入， 在过去的5年里，美国的市场已经大大改变了甲基苯丙胺现在的环境。 采用被称为“阿片类药物流行病的第四波”是芬太尼和芬太尼联合使用的激增。 冰毒轶事证据表明，芬太尼及其类似物是如此强大，人们 有动机共同使用甲基苯丙胺，以克服伴随芬太尼使用的重度镇静作用。 因此，我们对甲基苯丙胺注射动机的理解必须在 这个新的背景。我们还需要更新我们对注射甲基苯丙胺的人是如何 在芬太尼时代感染传染病的风险增加。20世纪90年代和21世纪初的数据显示， 显示增加注射器共享和性风险，目前还不清楚这些是否坚持在新的浪潮， 甲基苯丙胺注射剂及其与芬太尼的共同使用。与阿片类药物过量死亡相反， 由于呼吸抑制，我们对死亡的根本原因的分布知之甚少， 冰毒过量美国唯一的流行病学研究表明， 死亡原因为脑出血（15%）和心脏病（6%）。这项研究早于共同- 使用芬太尼，之后过量死亡人数激增。如果我们不知道为什么人们使用 甲基苯丙胺正在死亡，我们无法解决如何防止这种死亡。目标1：确定 注射甲基苯丙胺的动机目标2：评估甲基苯丙胺与 芬太尼与传染病危险行为的共同使用。目标3：确定潜在的 急性甲基苯丙胺中毒死亡的人的死亡原因。实现 目标1和2，我们将招募一个以社区为基础的800人的队列，他们使用有针对性的药物注射毒品， SF和OAK的抽样方法。我们将在基线和每月进行调查，为期6个月，使用7- 日时间轴跟踪方法。为达到目标3，我们将确定所有过量死亡的原因， 2016年至2024年涉及甲基苯丙胺的死亡人数，通过审查SF中的体检记录 （估计N=500）。研究结果将为政策制定者、卫生部门、 以及与注射甲基苯丙胺的人合作以减轻随之而来的健康风险的机构。