Housing Policies and their Impact on Engagement in Substance Use Treatment and Overdose Risk during the COVID-19 Pandemic

项目摘要 物质使用障碍（SUD），过量风险和住房不安全在美国已经达到危机水平。在 2019年，超过800万人符合SUD标准，近3700万家庭的支出增加 超过30%的收入用于住房。自2019冠状病毒病大流行开始以来， 死亡率飙升，数百万家庭拖欠房租。除了重点关注的举措之外 关于没有住房的人，如住房第一，一直缺乏研究，重点是 南部非洲发展共同体和住房不安全的交叉点。更不知道的是，政策是否旨在 支持住房保障有可能改善对药物使用治疗的参与， 致命性和非致命性过量。在COVID-19大流行期间颁布的创新住房政策，包括 暂停驱逐、紧急租房援助和向面临驱逐的租户提供法律的代理（ 提供了一个前所未有的机会来填补这一重要的知识空白。广泛的变化， 这些政策是否以及如何实施的国家允许使用因果关系对它们进行严格研究。 方法与机制和潜在的机制探讨使用定性方法。在目标1-2中，我们 将进行一项50个州的研究，使用差异中的差异方法来检查这三个因素的影响。 关于药物使用治疗率以及致命和非致命药物过量的住房政策。数据 目标1-2的资源将包括50个州的行政数据库，这些数据库记录了在一般情况下提供的服务 医疗部门（IQVIA LRx/Dx和HCUP）和专业成瘾治疗部门（TEDS）以及CDC 致命药物过量数据。在目标3中，我们将对最近有过类似经历的人进行深入的定性访谈。 吸毒史以及城市和农村县的供应商和政策官员。我们的研究将产生 可采取行动的证据，为住房和可持续发展的交叉领域的政策制定和执行提供信息 旨在加强对成瘾治疗的参与，防止药物过量。

Project Summary Substance use disorder (SUD), overdose risk, and housing insecurity have reached crisis levels in the US. In 2019, over 8 million individuals met criteria for SUD, and nearly 37 million households were spending more than 30% of their income on housing. Since the start of the COVID-19 pandemic, already-high overdose mortality rates soared, and millions of households have fallen behind on their rent. Beyond initiatives focused on people without housing such as housing first, there has been a paucity of research focusing on the intersection of SUD and housing insecurity. Even less is known about whether policy attempts designed to support housing security have the potential to improve engagement in substance use treatment and reduce fatal and non-fatal overdose. Innovative housing policies enacted during the COVID-19 pandemic—including eviction moratoriums, emergency rental assistance, and legal representation to tenants facing eviction (right to counsel)—offer an unprecedented opportunity to fill this vital knowledge gap. Widespread variation across states in whether and how these policies were implemented allow them to be rigorously studied using causal methods with mechanisms and potential mechanisms explored using qualitative approaches. In Aims 1-2, we will conduct a 50-state study using a difference-in-differences approach to examine the effects of the three housing policies of interest on rates of substance use treatment and fatal and non-fatal drug overdose. Data sources for Aims 1-2 will include 50-state administrative databases capturing services delivered in the general medical sector (IQVIA LRx/Dx and HCUP) and specialty addiction treatment sector (TEDS), as well as CDC fatal drug overdose data. In Aim 3, we will conduct in-depth qualitative interviews with people with recent histories of drug use as well as providers and policy officials in urban and rural counties. Our study will yield actionable evidence to inform policy development and implementation at the intersection of housing and SUD designed to enhance engagement in addiction treatment and prevent drug overdose.