Mixed methods study of polysubstance use to optimize overdose prevention

项目摘要 多药滥用(PDU)越来越多地被认为是美国吸毒过量危机的关键因素， 仅在去年一年就造成了超过10万美国人的死亡。服药过量的情况仍然很严重 与阿片类药物的使用有关，但也绝大多数发生在药物组合的背景下--值得注意的是 兴奋剂和合成阿片类药物。2019年，东北地区服药过量死亡比例最高 涉及合成阿片类药物和与兴奋剂有关的过量死亡的最大绝对增幅，以及 马里兰州的过量服药率是全国最高的之一。预防服药过量的基础设施还没有 但已针对PDU和相关体验的异构性进行了优化。具有多层次的 受生命历程和社会网络理论的启发，我们提出了一种多阶段混合方法 研究人群中PDU和过量用药的模式、轨迹、危险因素和保护因素 有不同的兴奋剂和阿片类药物使用模式。我们将使用艾滋病患者的行为数据 静脉体验(ALIVE)研究以确定PDU模式和轨迹，混合方法数据来自 2019年全州药物使用和服务民族志评估(SEADS)项目，以确定描述性 药物使用过渡和稳定时期的PDU轨迹和背景，以及互补的质量 收集生命历程数据(n=100)，以探索与不同类型相一致的最新变化和生命历程事件 这将反过来为PDU类型和过量用药的风险和保护因素的统计模型提供信息。 这项研究的结果将使计划规划者能够估计PDU之间的异质性的范围和规模 并开始理清PDU独特子组的干预需求。该项目将导致具体的 关于量身定做的减少过量风险的方法和支助资源的建议 PDU的异构性需求和PDU轨迹的关键转折点。我们将把我们的发现和 与当地利益相关者、合作伙伴组织和政府合作，进行广泛传播 各机构实时告知过量用药和治疗计划，并跨越所有三个项目年。

Project Summary Polydrug use (PDU) is increasingly implicated as a crucial factor underlying the U.S. overdose crisis, responsible for the deaths of over 100,000 Americans in the past year alone. Overdose is still highly associated with opioid use, but also overwhelmingly occurs in the context of combinations of drugs - notably stimulants and synthetic opioids. In 2019, the Northeast had the highest proportion of overdose deaths involving synthetic opioids and the largest absolute increase in stimulant-involved overdose deaths, and the Maryland overdose rate was among the highest in the country. The overdose prevention infrastructure has not yet been optimized to address PDU and the heterogeneity of associated experiences. With a multi-level perspective informed by life course and social network theories, we propose a multi-phase mixed methods study to examine patterns, trajectories, and risk and protective factors for PDU and overdose among people with various patterns of stimulant and opioid use. We will use behavioral data from the AIDS Linked to the IntraVenous Experience (ALIVE) study to identify PDU patterns and trajectories, mixed methods data from the 2019 Statewide Ethnographic Assessment of Drug Use and Services (SEADS) project to identify descriptive PDU trajectories and contextualize periods of drug use transition and stability, and complementary qualitative life course data collection (n=100) to explore recent changes and life course events aligned with different types of PDU, which will in turn inform statistical models of risk and protective factors for PDU types and overdose. Results from this study will allow program planners to estimate range and scale of heterogeneity among PDU and begin to disentangle intervention needs of unique sub-groups of PDU. This project will result in specific recommendations for tailored overdose risk reduction approaches and supportive resources for the heterogeneous needs of PDU and key turning points of PDU trajectories. We will translate our findings and conduct broad dissemination, working with local stakeholders, partner organizations, and governmental agencies to inform overdose and treatment programs in real time and across all three project years.