A Longitudinal Qualitative Study of Fentanyl-Stimulant Polysubstance Use Among People Experiencing Homelessness

无家可归者使用芬太尼兴奋剂多物质的纵向定性研究

• 批准号: 10590218
• 负责人: Kelly Ray Knight
• 金额: $ 249.96万
• 依托单位: YALE UNIVERSITY
• 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/10590218
• 关键词: Address; Americas; Area; Black Populations; COVID-19; COVID-19 pandemic; Cities; Cocaine; Collaborations; Crack Cocaine; Data Collection; Drug usage; Emergency Situation; Environment; Epidemic; Ethnography; Fentanyl; Focus Groups; Funding; Gender; High Prevalence; Homelessness; Housing; Intervention; Interview; Knowledge; Latinx population; Lead; Methamphetamine; Naloxone; New York; Opioid; Outcome; Overdose; Pattern; Persons; Pharmaceutical Preparations; Policies; Population; Process; Qualitative Research; Recommendation; Reporting; Request for Proposals; Research; Risk; Sampling; San Francisco; Shapes; Stimulant; Stimulant overdose; Substance Use Disorder; Suspensions; Targeted Research; Time; Translating; Woman; cohort; contextual factors; experience; expiration; follow-up; gender difference; gender diversity; health disparity; life history; men; mortality; novel; opioid use disorder; overdose death; overdose prevention; polysubstance use; prevention service; programs; prospective; racial disparity; racial diversity; racial health disparity; racial population; recruit; research study; response; service providers; stimulant use; substance use; synthetic opioid; treatment response; treatment services

Project Summary: We propose a five-year prospective, longitudinal qualitative study that will characterize fentanyl-stimulant (cocaine, crack cocaine, methamphetamine) polysubstance use among people experiencing homelessness across two cities (New York, NYC; San Francisco, SF). More than 100,000 overdose deaths occurred in the US in the one-year period ending April 2021. Nearly half involved the co-use of opioids (primarily fentanyl) and stimulants. People experiencing homelessness report higher prevalence of fentanyl-stimulant polysubstance use and are more vulnerable to drug-related harms. Fentanyl-stimulant polysubstance use is a likely contributor to widening racial disparities in overdose mortality, and yet relationships between fentanyl- stimulant polysubstance use, drug-related harms, and racial health disparities are not well-understood. Similar to cities in the US, NYC and SF are experiencing rising homelessness and overdoses, especially among Black and Latinx populations. NYC and SF are implementing comprehensive overdose prevention and SUD treatment responses, including naloxone and drug-checking programs, MOUD expansion, and, recently in NYC, overdose prevention centers. Gender differences in engagement with these prevention and treatment services are understudied. Homelessness crises in both cities have catalyzed novel housing interventions. Yet, we lack the knowledge about relationships between polysubstance use and housing trajectories, drug-related harms, and engagement with overdose prevention and SUD treatment services that is needed to inform more effective responses to the overdose epidemic. Building on our extensive experience studying drug use patterns and their implications for drug-related harm, we propose the following specific aims: SA1: To characterize fentanyl- stimulant polysubstance use patterns among people experiencing homelessness and examine how these patterns evolve over time due to changes to housing status and engagement with overdose prevention and SUD treatment interventions. SA2: To explore how fentanyl-stimulant polysubstance use patterns shape overdose vulnerability over time among people experiencing homelessness. SA3: To implement an integrated stakeholder engagement process to translate qualitative findings to inform overdose prevention, SUD treatment, and housing strategies and future research targeting fentanyl-stimulant use. Informed by the equity-focused Intersectional Risk Environment framework, we will: (1) conduct baseline and annual follow-up qualitative interviews and ethnographic fieldwork (Years 1-4) with a cohort of fentanyl-stimulant-using people experiencing homelessness (n=120) sampled for racial and gender diversity (SA1&2); (2) conduct targeted qualitative interviews on emergent fentanyl-stimulant polysubstance use dynamics (Years 3&4); and (3) in collaboration with our Stakeholder Engagement Board, recruit a stakeholders cohort (n=50; people with lived experience, substance use and housing policymakers and service providers) for interviews (Year 1) and focus groups (Years 4 & 5), to co-develop evidence-informed, scalable research, policy and program recommendations (SA3).

项目摘要：我们提出了一项为期五年的预期，纵向定性研究，将其特征 芬太尼 - 刺激剂（可卡因，可卡因，甲基苯丙胺）在经历的人中使用多刺激性 两个城市的无家可归（纽约，纽约；旧金山，SF）。超过100,000人过量死亡 截至2021年4月的一年中发生在美国。几乎一半涉及阿片类药物的共同使用（主要是 芬太尼）和兴奋剂。经历无家可归的人报告芬太尼刺激剂的患病率更高 使用多物质，更容易受到与药物有关的危害的影响。芬太尼刺激的多核固定使用是 可能导致扩大过量死亡率的种族差异的原因，而芬太尼 - 刺激性的多物质使用，与药物有关的危害和种族健康差异并不理解。相似的 对于美国的城市，纽约市和SF的无家可归和过量，尤其是在黑人中 和拉丁人种群。纽约市和SF正在实施全面的预防和SUD治疗 响应，包括纳洛酮和毒品检查计划，MOUD扩展，最近在纽约市，过量 预防中心。在参与这些预防和治疗服务方面的性别差异是 研究了。这两个城市的无家可归危机都促进了新型住房干预措施。但是，我们缺乏 关于多物结构使用与住房轨迹，与毒品有关的危害以及 参与预防过量和SUD治疗服务，以告知更有效 对过量流行的反应。基于我们研究药物使用模式及其的广泛经验 对与药物相关的伤害的影响，我们提出以下具体目的：SA1：表征芬太尼 - 刺激性的多物质使用模式在经历无家可归的人中并研究这些方式 由于住房状况的变化以及预防过量和SUD的参与，模式会随着时间的流逝而发展 治疗干预措施。 SA2：探索芬太尼刺激的多物质使用模式如何形状过量 随着时间的流逝，遇到无家可归者的脆弱性。 SA3：实施综合利益相关者 转化定性发现的参与过程，以告知预防过量，SUD治疗和 住房策略和未来的针对芬太尼刺激使用的研究。以股票为中心的 交叉风险环境框架，我们将：（1）进行基线和年度随访定性 访谈和民族志实地调查（1 - 4年）与一群芬太尼刺激的人一起经历 为种族和性别多样性采样无家可归（n = 120）（SA1＆2）； （2）进行有针对性的定性 关于新兴芬太尼刺激性多物质的访谈使用动力学（第3和4年）； （3）合作 在我们的利益相关者参与委员会中，招募利益相关者队列（n = 50；有经验的人， 访谈（第1年）和焦点小组（年份 4＆5），共同开发证据，可扩展的研究，政策和计划建议（SA3）。