An ethno-epidemiological study of the implementation and effectiveness of an innovative and comprehensive response to the evolving overdoseepidemic

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PROJECT SUMMARY/ABSTRACT Overdoses deaths have increased sharply in Canada and the US since the outset of the COVID-19 pandemic. While fentanyl is a critical driver of North America’s overdose epidemic, rising fentanyl-stimulant polysubstance use and ongoing drug supply changes (fluctuating fentanyl potency, adulteration of fentanyl with novel psychoactive substances) are worsening the situation and pose challenges to overdose prevention and addiction treatment approaches. There has been a lack of research into these emerging dynamics and how they intersect with social, structural, and environmental influences to shape overdose vulnerability and the effectiveness of the overdose response. Based in Vancouver, Canada, this study will employ an innovative ethno-epidemiological approach to address this critical research gap by: (1) characterizing how evolving drug use patterns and supply changes impact overdose vulnerability; (2) examining how changing drug use patterns and drug supply changes intersect with social, structural, and environmental influences to impact the effectiveness of overdose prevention interventions; and (3) exploring social, structural, and environmental influences on treatment outcomes for existing and emerging opioid agonist treatment (OAT) approaches among fentanyl-stimulant polysubstance- using and NPS exposed PWUD. Vancouver is the ideal setting to undertake the proposed research. Vancouver had implemented innovative overdose prevention and addiction treatment interventions that led to significant decreases in overdose deaths and that were later implemented – or are now being considered – elsewhere in the US and internationally, including drug checking programs, supervised consumption sites, and low-threshold oral and injectable OAT. This comprehensive overdose response is being adapted in response to rising overdose deaths attributed to fentanyl-stimulant polysubstance use and drug supply changes, including by expanding drug-checking approaches (benzodiazepine testing strips), expanding OAT options (e.g., oral and injectable OAT), implementing supervised inhalation services, and integrating OAT a contingency management and detoxification services. This study will be nested within the research infrastructure of the BC Centre on Substance Use, which includes three NIDA-funded, longitudinal cohort studies of PWUD and a NIDA-funded drug-checking program evaluation. This approach will enable epidemiologically-informed sampling and targeted recruitment of PWUD and facilitate the integration of qualitative data and cohort-based and drug surveillance data. Extending our ethno-epidemiological research to examine how a comprehensive response to the overdose epidemic is being adapted to rising fentanyl-stimulant polysubstance use and drug supply changes will result in a more nuanced and complete understanding of influences on the effectiveness of the overdose response than is possible through epidemiological research alone. The proposed research is aligned with NIH and NIDA strategic priorities and will generate evidence critical to optimizing the response to the overdose epidemic.