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前瞻性、纵向定性研究， 芬太尼兴奋剂（可卡因、快克可卡因、甲基苯丙胺） 两个城市（纽约州纽约;旧金山弗朗西斯科）的无家可归者。超过100，000人死于过量用药 于截至二零二一年四月止一年期间在美国发生。近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兴奋剂的患病率较高 使用多种物质，更容易受到与毒品有关的伤害。芬太尼类兴奋剂是一种 可能是导致过量死亡率种族差异扩大的原因，但芬太尼- 兴奋剂多种物质的使用，与毒品有关的危害，以及种族健康差异没有得到很好的理解。类似 在美国的城市，纽约市和旧金山正在经历越来越多的无家可归者和吸毒过量，特别是黑人 拉丁裔人口。纽约市和旧金山正在实施全面的过量预防和SUD治疗 反应，包括纳洛酮和药物检查计划，MOUD扩展，以及最近在纽约市，过量 预防中心。参与这些预防和治疗服务的性别差异是 替补演员这两个城市的无家可归危机催生了新的住房干预措施。然而，我们缺乏 了解多种物质使用与住房轨迹、毒品相关危害之间的关系， 参与过量预防和SUD治疗服务，需要告知更有效的 对吸毒过量的反应根据我们在研究毒品使用模式及其 对毒品相关危害的影响，我们提出以下具体目标：SA 1：描述芬太尼的特征- 在经历无家可归的人中使用刺激性多物质的模式，并研究这些 随着时间的推移，由于住房状况的变化以及过量预防和SUD的参与， 治疗干预。SA 2：探索芬太尼兴奋剂多物质使用模式如何影响过量 无家可归者的脆弱性。战略领域3：实施综合利益攸关方 参与过程，将定性结果转化为过量预防、SUD治疗和 住房战略和今后针对芬太尼兴奋剂使用的研究。以股权为中心的 交叉风险环境框架，我们将：（1）进行基线和年度跟踪定性 访谈和人种学实地考察（1-4年）与芬太尼兴奋剂使用人群经历 无家可归者（n=120）种族和性别多样性抽样（SA1&2）;（2）进行有针对性的定性 关于紧急芬太尼兴奋剂多物质使用动态的访谈（第3年和第4年）;以及（3）合作 与我们的利益相关者参与委员会，招募利益相关者队列（n=50;具有实际经验的人， 药物使用和住房政策制定者和服务提供者）进行访谈（第一年）和重点小组（第二年 4和5），共同开发循证的，可扩展的研究，政策和计划建议（SA 3）。