Evaluating the decriminalization of non-prescribed buprenorphine in Rhode Island

摘要文本 2021年7月，罗得岛成为美国第二个将拥有毒品合法化的州。 非处方丁丙诺啡（NPB），部分激动剂阿片类药物被证明有效治疗 阿片类药物使用障碍（OUD），继佛蒙特州的非刑罪化NPB的前一个月。作为国家 与历史上最严重的致命过量危机作斗争，纽约州认为， 为了使2000万居民的NPB合法化，需要了解 这种对人们消费丁丙诺啡的合法化， OUD，并作为自我治疗或减少伤害的一种形式。然而，迄今为止， 进行了。NPB合法化是对过量危机的一种新颖回应， 大多数NPB消费的目的是自我治疗的人谁没有获得 治疗，或不认为自己准备好在正式的治疗方案中取得成功。它还 与意外过量的减少有关，并被用作一种保护形式， 掺假的非法毒品供应与此同时，决策者和立法者的担忧依然存在 消费NPB不必要地延迟参与更全面的正式治疗， 当与非阿片类镇静剂联合使用时，它可能导致过量， 在娱乐性消费时会导致成瘾，特别是对阿片类药物未使用过的人。的目标 本研究旨在探讨NPB合法化对以下行为的态度和信念的影响： 丁丙诺啡在罗得岛，和丁丙诺啡的变化与致命过量。它 提供了一个机会，系统地研究如何在刑法的变化规范的待遇， 药物治疗会影响人们对它的态度和行为，允许快速和广泛地应用药物治疗。 调查结果。采用定性和定量措施，并将其努力与 研究人员在佛蒙特州进行同伴评估，研究小组将来到一个 了解1）知识，信念，和行为关于非犯罪化的NPB的人， 使用非法阿片类药物; 2）NPB合法化对罗得岛执法实践的影响， 态度和信仰，以及3）丁丙诺啡与 使用来自罗得岛州意外药物过量报告系统的数据。 其结果将产生科学出版物和产品，分发给公共行政部门 和社区利益相关者受众。这项研究将有助于了解 非刑事化的NPB作为纽约和其他国家考虑什么作用NPB非刑事化应该 在公共卫生战略中发挥作用，并将揭示最具洞察力的研究问题和指标 用于在随后的R 01研究中衡量非犯罪化的健康和危害减少结果。

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.