Preferences and predictors driving opioid-involved polysubstance use profiles and trajectories: Implications for improving care

项目总结/摘要 最近过量死亡率的变化是由多物质相关死亡的快速增加所驱动的， 最常见的包括阿片类药物，然后是兴奋剂。先前的研究已经发现重要的个体（例如， 黑人/非裔美国人种族，共病的精神/身体健康），社会（例如，家庭支持）和社区 因素（例如，治疗可用性）与PSU、治疗和结局相关。然而， 关于可修改的个人层面的激励因素（例如，用于缓解戒断）和偏好驱动高- 风险多物质使用（PSU）行为（例如，静脉使用，阿片类药物相关PSU的频率较高， 故意使用合成类阿片和同时使用药物），这一点很重要， 定制治疗服务。行为经济学（BE）理论提供了一个新的框架和目标， 了解物质使用偏好的措施，强调物质使用受药物影响 估值（即，需求）和不确定的负面结果的贬值（例如，过量风险） 环境，并可以告知临床护理。这一点尤其重要，因为涉及阿片类药物的PSU患者 是最不可能接受有效的过量预防或治疗的人。正如我们所看到的，虽然 > 85%死于阿片类药物、兴奋剂或酒精过量的人是在医疗机构中看到的 (e.g.,初级和精神卫生保健），只有一小部分人得到有效的护理，这表明新的战略是 卫生系统是这一人群的重要共同接触点。数据 是非常需要了解这些复杂的个人层面的模式，动机和偏好驱动 PSU，沿着已知的社区和社会因素，以改善对阿片类药物相关PSU患者的护理。 我们将进行一项前瞻性队列研究（N = 400），招募不同的阿片类药物成人样本， 涉及PSU（过度采样兴奋剂共同使用和黑人/非裔美国人，以提高代表性），从2 密歇根州的大型医疗系统。基线入组后，我们将每周收集详细数据， 捕捉使用和共同使用的细微和动态模式和动机（例如，同时或顺序， 过量危险行为等）超过四周。基线、4个月、8个月和12个月期间的其他指标 (e.g.,行为经济学选择偏好，共病心理/身体健康，功能，其他社会和 社区因素和治疗使用）将提供关于概况和纵向 PSU行为和治疗的轨迹。将通过利益相关者访谈补充队列数据， 阐明患者和提供者对PSU的观点以及如何定制策略（例如，纳洛酮和低屏障 MOUD治疗），以提高吸收。该项目将通过提供关键的新的公共卫生影响， 对PSU的动机和模式的见解，在PSU配置文件中的BE选择偏好，以及细微差别 PSU和治疗的模式和轨迹，以告知可在 卫生系统，以改善不同人群的健康和结果与PSU。

Project Summary/Abstract Recent changes in overdose mortality are driven by rapid increases in polysubstance-involved deaths, most often including opioids followed by stimulants. Prior studies have found important individual (e.g., Black/African American race, comorbid mental/physical health), social (e.g., family supports), and community factors (e.g., treatment availability) associated with PSU, treatment, and outcomes. However, little is known about the modifiable individual-level motivators (e.g. use to alleviate withdrawal) and preferences driving high- risk polysubstance use (PSU) behaviors (e.g., intravenous use, higher frequency of opioid-involved PSU, intentional use of synthetic opioids, and simultaneous use of substances), which is important to inform and tailor treatment services. Behavioral economic (BE) theory provides a novel framework and objective measures to understand substance use preferences, emphasizing substance use is impacted by drug valuation (i.e., demand) and devaluing of uncertain negative outcomes (e.g., overdose risk) in complex environments and can inform clinical care. This is especially critical given that people with opioid-involved PSU are among the least likely to receive effective overdose prevention or treatments. As we have shown, although >85% of people who died from opioid, stimulant or alcohol-involved overdose are seen in healthcare settings (e.g., primary and mental health care), only a tiny fraction receive effective care, suggesting new strategies are needed that can be implemented in health systems, an important common touchpoint for this population. Data are critically needed to understand these intricate individual-level patterns, motivators and preferences driving PSU, along with known community and social factors, to improve care for people with opioid-involved PSU. We will conduct a prospective cohort study (N=400), recruiting a diverse sample of adults with opioid- involved PSU (over-sampling stimulant co-use and Black/African Americans to enhance representation) from 2 large health systems in Michigan. Following baseline enrollment, we will collect weekly detailed data to reliably capture nuanced and dynamic patterns and motivators of use and co-use (e.g., simultaneous or sequential, overdose risk behaviors, etc.) over four weeks. Additional measures across baseline, 4-,8-, and 12-months (e.g., behavioral economic choice preferences, comorbid mental/physical health, functioning, other social and community factors, and treatment use) will provide comprehensive information on profiles and longitudinal trajectories of PSU behaviors and treatment. Cohort data will be complemented by stakeholder interviews to elucidate patient and provider perspectives on PSU and how to tailor strategies (e.g., naloxone and low-barrier MOUD treatment) to enhance uptake. This project will have high public health impact by providing critical new insights on motives and patterns of PSU, BE choice preferences across PSU profiles, as well as nuanced patterns and trajectories of PSU and treatment to inform actionable strategies that can be implemented in health systems to improve health and outcomes across the diverse population of people with PSU.