Risk and Protective factors of Polydrug Overdose in North Carolina

摘要 从2020年4月新冠肺炎在美国大流行到2021年4月，有超过 美国有10万人死于药物过量。据估计，药物过量流行目前使 美国每年约1万亿美元。在过去的5-7年里，涉及多种药物(多药)的药物过量 增长特别快。现在，美国超过60%的药物过量死亡涉及多种药物， 特别是非法芬太尼与处方阿片类药物、可卡因、苯二氮卓类药物和兴奋剂混合。在北方 卡罗莱纳州(北卡罗来纳州)，这项拟议研究的重点，超过70%的过量死亡涉及 多药过量，其中53%涉及至少一种阿片类药物，19%涉及多种非阿片类药物 阿片类药物。在少数族裔美国人中，多药过量的情况也在不成比例地增加。 医疗保健、保险公司和矫正等系统，这些系统有可能实施大规模预防 倡议缺乏相关数据来建立其人口中多药过量发生率的基准和 定义风险和保护因素。许多死于多药过量的人最近接触过 医疗保健、保险或惩教系统。事实上，接受医疗补助的个人的药物过量死亡率 而那些从教养所释放的人比普通人口要高得多。更进一步地说， 处方类阿片治疗急性、手术后或慢性疼痛导致多药使用和过量用药不是 明白了。了解多药使用途径和物质使用障碍是很重要的。 通过吸毒者和治疗提供者的生活经验进行治疗。 因此，在这项混合方法研究中，我们将在四个大的 代表公共和私人参保个人、卫生系统患者和获释人员的人口 在16年内免于监禁；确定人口统计、临床以及短期和长期护理的可及性 预测四个人群中每一个人致命的多药过量风险的模式和因素；确定 处方阿片类疼痛管理轨迹在急性，手术后， 和慢性疼痛与致命的多药过量的风险增加有关；并阐明 多药使用和服药过量的途径有生活经验的人，了解有效的障碍 物质使用障碍治疗以及与提供者提供的此类治疗和减少伤害的联系 专业人士。我们还将检查预测模型中的种族差异和种族算法偏差 开发工具，帮助临床医生和惩教人员识别使用多种药物的高危人群 过量死亡，并将他们与适当的治疗方案联系起来。这项工作将利用数据资源 以及从我们先前和正在进行的研究中形成的联系，从而最大限度地利用资源，并极大地 通过卫生系统、保险提供者、 以及北卡罗来纳州和美国的修正。

ABSTRACT From April 2020, the start of the COVID-19 pandemic in the US, to April 2021, there were more than 100,000 drug overdose deaths in the US. It is estimated that the drug overdose epidemic currently costs the US about $1 trillion each year. Over the past 5-7 years, drug overdoses involving multiple drugs (polydrug) has increased especially rapidly. More than 60% of all drug overdose deaths in the US now involve multiple drugs, especially illicit fentanyl mixed with prescription opioids, cocaine, benzodiazepines, and stimulants. In North Carolina (NC), the state where the proposed study focuses, more than 70% of overdose deaths involve polydrug overdoses, including 53% which involve at least one opioid and 19% which involve multiple non- opioids. Polydrug overdoses are also increasing disproportionately among racial/ethnic minority Americans. Systems like healthcare, insurers, and corrections, which have the potential to implement large prevention initiatives, lack the linked data to establish benchmarks of polydrug overdose incidence in their populations and define risk and protective factors. Many people who die from polydrug overdose have had recent contact with healthcare, insurance, or correctional systems. In fact, drug overdose death rates from individuals on Medicaid and those released from correctional settings are much higher than the general population. Further, the role of prescription opioids for acute, post-surgical, or chronic pain in leading to polydrug use and overdose is not understood. It is important to understand pathways to polydrug use and barriers to substance use disorder treatment through the lens of lived experience of persons who use drugs and treatment providers. Therefore, in this mixed-methods study, we will define polydrug overdose rates and trends in four large populations representing publicly and privately insured individuals, health system patients, and those released from incarceration over a 16-year period; identify demographic, clinical, and short- and long-term care access patterns and factors that predict risk of fatal polydrug overdoses in each of the four populations; identify prescription opioid pain management trajectories in longitudinal cohorts of patients with acute, post-surgical, and chronic pain that are associated with increased risk of fatal polydrug overdoses; and elucidate the pathways to polydrug use and overdose people with lived experience and understand barriers to effective substance use disorder treatment and linkage to such treatment from providers and harm reduction professionals. We will also examine racial disparities and racial algorithmic bias in prediction models and develop tools that may aid clinicians and corrections officers to identify people at high risk for polydrug overdose deaths and connect them with appropriate treatment options. This work will leverage data resources and linkages developed from our prior and ongoing studies, thereby maximizing resources, and greatly advancing our ability to develop evidence-based interventions through health systems, insurance providers, and corrections in North Carolina and the United States.