CE23-002 - Assessing the Impact of Overdose Prevention Centers as a Polysubstance Use and Behavioral Health Intervention in New York City

项目总结/摘要 在美国，药物过量的流行仍然有增无减。毒品供应的变化和 与兴奋剂有关的过量死亡已经将阿片类药物过量流行病转变为多种物质 吸毒过量的流行病现在全国超过一半的过量死亡涉及多种物质，导致一些 研究人员将目前的多物质时代确定为流行病的“第四波”。多种物质增加 使用（PSU）和PSU过量给从业者和研究人员带来了许多挑战。知道 新出现的减少伤害干预措施是否以及在多大程度上可以减少PSU涉及的过量风险， 对公共卫生当局和服务提供者至关重要。过量预防中心（OPCs），社区- 个人在受过培训的监督下消费预先获得的受控物质的设施 在发生药物过量的情况下能够进行干预的工作人员就是这样一种干预。全球有200多家OPCs运营， 2021年，美国首批两家公开认可的OPC在纽约市开业。OPCs其他 国家与减少致命和非致命过量风险和减少紧急服务有关 利用率然而，先前的研究尚未评估OPC使用对PSU过量风险的影响- 涉及人口。此外，并发精神健康障碍仍然是一个关键但未充分探讨的风险 PSU过量和其他危害的因素，但迄今为止的研究尚未评估OPC之间的关联 使用和心理健康结果，尽管估计表明， OPC客户端因此，本K 01提案的目标是解决这些关键的研究差距，以：（1）确定 OPC使用对参与PSU的个体的非致命性和致命性过量风险的异质性影响;（2） 估计OPC使用对PSU患者治疗精神病事件的影响;（3）评估需求 减少伤害提供者将心理健康服务整合到现有的注射器服务和OPC服务中 模式，特别注重涉及PSU的人口的需求。该研究计划得到了 优秀的导师团队和培训计划。拟议的项目建立在候选人的背景， 药物使用流行病学和数据科学，并在几个领域提供新的培训：（1）新的统计 确定OPC使用对PSU中过量风险的异质性治疗效应的方法- 涉及的个人;（2）精神病流行病学和心理健康之间的复杂关系， 物质使用障碍和PSU;（3）实施科学，概念化和评估新的 为PSU相关人群提供综合行为健康护理模式。联合研究和培训 该计划将使候选人过渡到政策相关的社会和 行为因素决定了过量用药的风险这项研究与CDC的过量预防研究一致 优先确定PSU过量风险和社会生态多个层面的保护因素。

PROJECT SUMMARY/ABSTRACT The overdose epidemic continues unabated in the United States. Changes to the drug supply and increases in stimulant-involved overdose deaths have shifted what was an opioid overdose epidemic to a polysubstance overdose epidemic. Over half of overdose deaths nationally now involve multiple substances, leading some researchers to identify the current polysubstance era as the epidemic’s “fourth wave.” Increases in polysubstance use (PSU) and PSU overdose pose a host of challenges for practitioners and researchers to address. Knowing whether and to what extent emerging harm reduction interventions can reduce PSU-involved overdose risk is critical for public health authorities and service providers. Overdose prevention centers (OPCs), community- based facilities at which individuals consume pre-obtained controlled substances under the supervision of trained staff who can intervene in event of an overdose, are one such intervention. Over 200 OPCs operate globally, but the first two publicly recognized OPCs in the United States opened in New York City in 2021. OPCs in other countries are associated with reduced fatal and non-fatal overdose risk and reduced emergency service utilization. However, prior research has not assessed the impact of OPC use on overdose risk among PSU- involved populations. In addition, concurrent mental health disorders remain a critical yet underexplored risk factor for PSU overdose and other harms, yet studies to date have not assessed the association between OPC use and mental health outcomes, despite estimates suggesting a high untreated mental health burden among OPC clients. As such, the objective of this K01 proposal is to address these critical research gaps to: (1) identify heterogeneous impacts of OPC use on non-fatal and fatal overdose risk among individuals engaging in PSU; (2) estimate the impact of OPC use on treated psychiatric events among clients with PSU; and (3) assess the needs of harm reduction providers to integrate mental health services into existing syringe service and OPC delivery models, with a particular focus on the needs of PSU-involved populations. The research plan is bolstered by an exceptional mentorship team and training plan. The proposed project builds on the candidate’s background in substance use epidemiology and data science and provides new training in several areas: (1) novel statistical methods for the identification of heterogeneous treatment effects of OPC use on overdose risk among PSU- involved individuals; (2) psychiatric epidemiology and the complex relationship between mental health, substance use disorders, and PSU; and (3) implementation science to conceptualize and evaluate novel integrated behavioral health care models for PSU-involved populations. The combined research and training plan will enable the candidate to transition into an independent researcher of policy-relevant social and behavioral factors that shape overdose risk. This research aligns with CDC’s Overdose Prevention Research Priorities to identify PSU overdose risk and protective factors across multiple levels of the social ecology.