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

项目摘要 在美国，物质使用障碍(SUD)、过量用药风险和住房不安全感已经达到了危机水平。在……里面 2019年，超过800万人符合SUD标准，近3700万家庭的支出更高 他们收入的30%以上用于住房。自新冠肺炎大流行以来，已经很高的服药过量 死亡率飙升，数百万家庭拖欠房租。超越重点计划 关于没有住房的人，比如住房优先，一直缺乏专注于 南德和住房不安全的交集。更不知道的是，政策尝试是否旨在 支持住房保障有可能改善物质使用治疗的参与度，并减少 致命的和非致命的服药过量。新冠肺炎大流行期间颁布的创新住房政策--包括 暂停驱逐、紧急租赁援助和向面临驱逐的租户提供法律代理(权利 律师)-提供了一个前所未有的机会来填补这一重要的知识缺口。存在广泛的差异 是否以及如何实施这些政策的国家允许使用因果关系对其进行严格的研究 方法用定性的方法探索机制和潜在的机制。在目标1-2中，我们 将进行一项50个州的研究，使用差异方法来检查这三个因素的影响 关于药物使用治疗以及致命和非致命药物过量的利率的住房政策。数据 AIMS 1-2的来源将包括50个州的行政数据库，这些数据库捕捉在一般情况下提供的服务 医疗部门(IQVIA LRx/Dx和HCUP)和专门成瘾治疗部门(TEDS)以及疾病预防控制中心 致命的药物过量数据。在目标3中，我们将对最近 城市和农村县的毒品使用史以及提供者和政策官员。我们的研究将产生 在住房和城市发展的交汇点为政策制定和实施提供可操作的证据 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.