Impact of prescription stimulants on the drug overdose epidemic

处方兴奋剂对药物过量流行的影响

• 批准号: 10676345
• 负责人: LAUREN V MORAN
• 金额: $ 79.29万
• 依托单位: MCLEAN HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676345
• 关键词: Abstinence; Acceleration; Accident and Emergency department; Adherence; Adult; Adverse event; Amphetamines; Benefits and Risks; Benzodiazepines; COVID-19 pandemic; Cessation of life; Characteristics; Clinical; Cocaine; Cocaine use disorder; Cohort Studies; Complement; Complement 3; Complex; Control Groups; Dangerousness; Data; Data Set; Data Sources; Databases; Death Certificates; Dose; Drug abuse; Early Intervention; Educational Activities; Emergency department visit; Emergency medical service; Epidemic; Fentanyl; Future; Goals; Guidelines; Heroin; Heterogeneity; Hospitals; Individual; Inpatients; Interdisciplinary Study; Internet; Knowledge; Link; Longterm Follow-up; Massachusetts; Methamphetamine; Methamphetamine use disorder; Methods; Modeling; NIH Program Announcements; National Institute of Drug Abuse; Observational Study; Opioid; Oregon; Outcome; Overdose; Overdose reduction; Patients; Pattern; Pharmaceutical Preparations; Pharmacy facility; Phase; Policies; Provider; Public Health; Recording of previous events; Records; Research; Risk; Risk Assessment; Role; Sample Size; Stimulant; Stimulant overdose; Substance Use Disorder; Therapeutic; Time; Toxicology; Translating; United States; Update; Work; amphetamine use; case control; continuing medical education; design; evidence base; fentanyl contamination; follow-up; heroin use; high risk; innovation; medication for opioid use disorder; novel; opioid epidemic; opioid overdose; opioid use; opioid use disorder; overdose death; overdose risk; pill; polysubstance use; prescription monitoring program; prescription opioid; prescription stimulants; prevent; protective effect; psychostimulant; randomized placebo controlled trial; response; stimulant use; stimulant use disorder; substance abuse treatment; substance use treatment; telehealthcare

ABSTRACT The use of prescription stimulants in adults has increased dramatically, with a five-fold increase in use of amphetamines between 2004 and 2019. Coinciding with increased prescribing of stimulants, there has been an acceleration of fatal overdoses involving illicit psychostimulants. During the COVID-19 pandemic, stimulant- related fatal overdoses reached the highest point on record, with 20,054 fatal overdoses involving cocaine and 23,352 involving methamphetamine in 2020 alone. While it is well-established that rising rates of prescription opioid use was associated with an increase in heroin use in turn fueling increases in fatal overdoses, it is not yet known if rising prescription stimulant use is associated with transition to illicit stimulants and overdoses involving illicit stimulants. This is of critical importance given high rates of fentanyl contamination in the illicit stimulant supply and counterfeit stimulant pills obtained from illegitimate online pharmacies. In addition to potential harmful effects, there are also some RCT’s suggesting prescription stimulants may promote short-term abstinence in individuals with pre-existing substance use disorders. Whether these benefits translate to reductions in overdose is unknown. The current application will fill a critical gap by using real-world evidence to identify the consequences of prescription stimulant use on drug overdoses. Our multidisciplinary research team will use robust real-world data sources linking prescription drug monitoring program data, state-wide all-payer claims data, emergency medical service data, emergency department visit and hospital discharge data, substance abuse treatment data and vital records (death certificate/toxicology) for ~ 10 million individuals from two states, Massachusetts and Oregon. In response to the NIDA program announcement RFA-DA-22-037 “Accelerating the Pace of Drug Abuse Research Using Existing Data, we will address three aims: 1) We will use a priori definition of high risk use, supported by preliminary data, to define the impact of high risk prescription stimulant use on the risk of fatal and non-fatal overdoses involving stimulants and/or polysubstance use; 2) We will assess the potential therapeutic role of prescription stimulants in preventing drug overdoses in individuals with stimulant and opioid use disorders; and 3) We will use group-based trajectory modeling to identify longitudinal stimulant prescribing patterns that may aid in predicting overdose. Aim 3 complements the other aims by capturing heterogeneity in prescribing patterns that may be associated with protective or increased risk of overdose. Given prescription stimulants are one of the most widely prescribed classes of medications in the United States, it is imperative to understand the risks/benefits of these medications with the overall goal of reducing stimulant-related overdose.

摘要 成人处方兴奋剂的使用急剧增加，使用量增加了五倍 在2004年至2019年期间，安非他明的数量。在兴奋剂处方增加的同时，出现了 涉及非法精神刺激剂的致命过量加速。在新冠肺炎大流行期间，兴奋剂- 相关致命过量达到有记录以来的最高点，20054例致命过量涉及可卡因和 仅在2020年就有23352起涉及冰毒的案件。虽然众所周知，处方率的上升 阿片类药物的使用与海洛因使用的增加有关，而海洛因的使用反过来又加剧了致命过量的增加，但事实并非如此 然而，目前尚不清楚处方兴奋剂使用量的增加是否与向非法兴奋剂和过量使用的转变有关 涉及非法兴奋剂。鉴于芬太尼在非法药物中的高污染率，这一点至关重要。 从非法网上药店获得的兴奋剂供应和假冒兴奋剂。 除了潜在的有害影响，还有一些RCT建议使用处方药 可能会促进有既往物质使用障碍的个人的短期戒断。不管是这些 好处转化为减少过量用药尚不清楚。当前的应用程序将通过使用 确定处方兴奋剂使用对药物过量的后果的真实证据。我们的 多学科研究团队将使用强大的真实世界数据源将处方药监测联系起来 计划数据、全州所有付款人索赔数据、紧急医疗服务数据、急诊科就诊 和出院数据、药物滥用治疗数据和生命记录(死亡证明/毒理学) 来自马萨诸塞州和俄勒冈州的约1000万人。 响应NIDA计划公告RFA-DA-22-037“加快药物开发的步伐” 虐待研究利用现有数据，我们将解决三个目标：1)我们将使用高的先验定义 风险使用，由初步数据支持，以确定高风险处方兴奋剂使用对风险的影响 涉及兴奋剂和/或多种物质使用的致命性和非致命性过量；2)我们将评估 处方兴奋剂在预防兴奋剂和阿片类药物滥用中的治疗作用 使用障碍；以及3)我们将使用基于群体的轨迹建模来识别纵向兴奋剂处方 可能有助于预测过量用药的模式。目标3通过捕获异构性来补充其他目标 处方模式可能与保护性或增加过量用药的风险有关。 处方兴奋剂是世界上最广泛使用的处方药之一 在美国，必须了解这些药物的风险/好处，总体目标是 减少兴奋剂相关的过量用药。