Evaluating the decriminalization of non-prescribed buprenorphine in Rhode Island

摘要文本 2021年7月，罗德岛州成为全国第二个将拥有 非处方丁丙诺啡(NPB)，部分激动剂阿片类药物被证明对治疗有效 阿片类药物使用障碍(OUD)，此前一个月佛蒙特州将NPB合法化。作为一个国家 应对历史上最严重的致命过量危机，纽约州考虑 将2000万居民的NPB合法化，有必要在时间上了解 对人们服用丁丙诺啡的非刑事化既是正式治疗的一部分 OUD，以及作为自我治疗或减少危害的一种形式。然而，到目前为止，还没有这样的评价 已经进行过了。根据证据，将NPB合法化是应对吸毒过量危机的一种新举措 大多数NPB消费是为了让那些无法获得 治疗，或者不认为自己已经准备好在正式的治疗方案中取得成功。它还 与意外过量用药的减少有关，并被用作预防 在非法药物供应中掺假。与此同时，政策制定者和立法者的担忧依然存在 消费NPB不必要地推迟了更全面的正规治疗的参与， 当与非阿片类镇静剂联合使用时，它可能会导致过量，而且它 当娱乐消费时，尤其是阿片类天真的人，会导致上瘾。的目标是 本项目旨在探讨将NPB合法化对人们对 罗德岛的丁丙诺啡，以及丁丙诺啡与致命过量的关系的变化。它 提供了一个机会，系统地研究规范治疗的刑法的变化如何 药物影响对它的态度和行为，允许快速和广泛的应用 调查结果。使用定性和定量措施，并密切协调其努力与 在佛蒙特州进行同伴评估的研究人员，研究小组将得出一个 了解1)以下人员关于非犯罪化NPB的知识、信念和行为 使用非法阿片类药物；2)将NPB合法化对罗德岛执法做法的影响， 态度和信念，以及3)非刑事化后丁丙诺啡与 使用罗德岛州非故意药物过量报告系统的数据进行致命过量。 结果将产生科学出版物和产品，分发给公共管理部门 和社区利益相关者受众。这项研究将产生对以下影响的理解 随着纽约和其他州考虑NPB合法化应该扮演什么角色，NPB合法化 在他们的公共卫生战略中发挥作用，并将揭示最有洞察力的研究问题和指标 在随后的R01研究中衡量非刑事化的健康和减少伤害结果。

ABSTRACT TEXT In July of 2021, Rhode Island became the second state in the nation to decriminalize the possession of non-prescribed buprenorphine (NPB), the partial agonist opioid medication proven effective at treating opioid use disorder (OUD), following Vermont’s decriminalization of NPB the month prior. As the nation contends with the worst fatal overdose crisis in its history, and New York State considers decriminalizing NPB for 20 million residents, there is a time-sensitive need to understand the effects of this decriminalization on people’s consumption of buprenorphine both as part of formal treatment for OUD, and as self-treatment or a form of harm reduction. To date, however, no such evaluation has been conducted. Decriminalizing NPB is a novel response to the overdose crisis, based on evidence that most NPB consumption is for the purpose of self-treatment by people who do not have access to treatment, or do not perceive themselves as ready to succeed in formal treatment programs. It has also been associated with decreases in accidental overdose, and used as a form of protection from an adulterated illicit drug supply. At the same time, concerns among policymakers and legislators persist that consuming NPB unnecessarily delays participation in more comprehensive formal treatment, that when used in combination with non-opioid depressants it can contribute to overdose, and that it contributes to addiction when consumed recreationally, especially by opioid-naïve people. The goal of this project is to explore the effects of decriminalizing NPB on attitudes and beliefs toward buprenorphine in Rhode Island, and changes in buprenorphine’s association with fatal overdoses. It offers the opportunity to systematically examine how a change in the criminal law regulating a treatment medication affects attitudes and behaviors regarding it, allowing for a rapid and broad application of the findings. Using qualitative and quantitative measures, and closely harmonizing their efforts with researchers conducting a companion evaluation in Vermont, the research team will come to an understanding of 1) the knowledge, beliefs, and behaviors regarding decriminalized NPB of people who use illicit opioids; 2) the effects of decriminalized NPB on Rhode Island law enforcement practices, attitudes and beliefs, and 3) any post-decriminalization changes in buprenorphine’s association with fatal overdoses using data from Rhode Island’s State Unintentional Drug Overdose Reporting System. The results will yield both scientific publications and products for distribution to public administration and community stakeholder audiences. The study will produce an understanding of the effects of decriminalized NPB as New York and other states consider what role NPB decriminalization should play in their public health strategies, and will reveal the most insightful research questions and metrics for measuring the health and harm reduction outcomes of decriminalization in an ensuing R01 study.