Risk and Protective factors of Polydrug Overdose in North Carolina

北卡罗来纳州多种药物过量的风险和保护因素

• 批准号: 10579463
• 负责人: Brian W Pence
• 金额: $ 35万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10579463
• 关键词: Risk; Protective; factors; Polydrug; Overdose

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.

抽象的 从2020年4月，即美国共同19日大流行开始到2021年4月，有更多 在美国，有100,000例药物过量死亡。据估计，药物过量流行目前使 我们每年大约1万亿美元。在过去的5 - 7年中，涉及多种药物的药物过量（Polydrug）已有 特别迅速增加。现在，美国所有药物过量死亡中有60％涉及多种药物， 特别是非法的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。在北部 卡罗来纳州（NC），拟议的研究重点的状态，超过70％的过量死亡涉及 多药剂量过量，包括至少涉及一种阿片类药物的53％，涉及多个非非 - 阿片类药物。在种族/少数民族的美国人中，多药量过量也在不成比例地增加。 医疗保健，保险公司和更正的系统，有可能实施大型预防 倡议，缺乏链接的数据，无法在其人群中建立多药过量发病率的基准 定义风险和保护因素。许多因多药过量死亡的人最近与 医疗保健，保险或惩教系统。实际上，药物过量的医疗补助人的死亡率过量 从惩教环境中释放的人远高于一般人群。此外， 急性，手术后或慢性疼痛的处方阿片类药物导致多药的使用和过量疼痛不是 理解。重要的是要了解多药用途径和吸毒障碍的障碍 通过使用药物和治疗提供者的人的生活经验的镜头进行治疗。 因此，在这项混合方法的研究中，我们将定义多药的过量速率和四个大型的趋势 代表公共和私人保险人，卫生系统患者以及发布的人群 从16年的监禁开始；确定人口，临床和短期和长期护理访问 预测四个人群中每个人的致命多药物过量风险的模式和因素；确认 处方阿片类药物疼痛管理轨迹的急性，术后患者的纵向人群中 和慢性疼痛与致命多药物过量的风险增加有关；并阐明 多药的使用途径和过量有经验的人，并了解有效的障碍 药物使用障碍的治疗和与提供者的治疗与这种治疗的联系和减少伤害 专业人士。我们还将研究预测模型中的种族差异和种族算法偏见 开发可能有助于临床医生和惩教人员确定Polydrug风险高风险的工具 过量的死亡并将其与适当的治疗选择联系起来。这项工作将利用数据资源 以及从我们的先前和正在进行的研究建立的联系，从而最大程度地提高资源，并极大地提高资源 促进我们通过卫生系统，保险提供商，制定循证干预措施的能力， 以及北卡罗来纳州和美国的矫正。