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 月新冠病毒 (COVID-19) 在美国开始大流行到 2021 年 4 月，已有超过 美国有 10 万人因吸毒过量死亡。据估计，目前吸毒过量流行病造成的损失 美国每年约1万亿美元。在过去的 5-7 年里，涉及多种药物（多种药物）的药物过量事件已经发生 增长尤其迅速。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。位于北部 卡罗来纳州（北卡罗来纳州）是拟议研究的重点州，超过 70% 的服药过量死亡涉及 多种药物过量，其中 53% 涉及至少一种阿片类药物，19% 涉及多种非药物过量 阿片类药物。在美国少数族裔中，多种药物过量的情况也在不成比例地增加。 医疗保健、保险公司和惩教等系统有可能实施大规模预防 缺乏相关数据来建立其人群中多种药物过量发生率的基准， 定义风险和保护因素。许多死于多种药物过量的人最近都接触过 医疗保健、保险或惩教系统。事实上，医疗补助个人的药物过量死亡率 从惩教机构释放的人数远高于总人口。此外，作用 处方阿片类药物治疗急性、术后或慢性疼痛不会导致多种药物的使用和过量 明白了。了解多种药物使用的途径和物质使用障碍的障碍非常重要 通过吸毒者和治疗提供者的生活经历来进行治疗。 因此，在这项混合方法研究中，我们将定义四大药物过量率和趋势 代表公共和私人保险个人、卫生系统患者和出院人员的人群 被监禁超过 16 年；确定人口统计、临床以及短期和长期护理的获取途径 预测四个人群中每一个人群致命的多种药物过量服用风险的模式和因素；确认 急性、术后、 与致命的多种药物过量风险增加相关的慢性疼痛；并阐明 多种药物使用和过量用药的途径 具有生活经验并了解有效障碍的人 物质使用障碍治疗以及提供者与此类治疗的联系以及减少伤害 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差 开发可以帮助临床医生和惩教人员识别多种药物高风险人群的工具 过量死亡并将其与适当的治疗方案联系起来。这项工作将利用数据资源 以及我们之前和正在进行的研究中建立的联系，从而最大限度地利用资源，并极大地 提高我们通过卫生系统、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更正。