Culturally Response Integrated Harm Reduction Services for Black and Latinx People Who use Drugs

这项研究是美国国立卫生研究院帮助结束长期成瘾（HEAL）倡议的一部分，该倡议旨在加速科学解决全国阿片类药物公共卫生危机。NIH HEAL倡议支持NIH的研究，以改善阿片类药物滥用和成瘾的治疗。2021年，有10万多人死于药物过量，这凸显了采取紧急行动的必要性。虽然白人的过量死亡率已经开始趋于平稳，但少数种族/少数民族的死亡率却急剧上升。其他物质的使用也存在明显的差异，包括黑人和拉丁裔吸毒者（PWUD）中的兴奋剂。虽然存在对问题物质使用的有效治疗，以及减少物质相关危害的减少伤害（HR）服务，但研究表明，种族/少数民族的人不太可能获得这些服务。他们不仅经历了与药物滥用有关的更多负面后果，而且也不太可能接受人力资源服务或保留在以证据为基础的治疗中，如MAT。为了解决这些独特的问题，我们创建了一个综合减少伤害干预（IHRI），以满足黑人和拉丁裔PWUD的移动和灵活的需求。这一具有文化敏感性的IHRI将雇用一名人力资源保健协调员，以评估健康社会决定因素方面的脆弱性，并将人们与所需服务联系起来。数据从

This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction. Over 100,000 people died from drug overdoses in 2021, underscoring the need for urgent action. While the rates of overdose deaths among White people have begun to plateau, there has been a drastic surge in deaths among racial/ethnic minoritized individuals. There are also stark disparities from other substance use, including stimulants among Black and Latinx people who use drugs (PWUD). While effective treatment exists for problematic substance use, along with harm reduction (HR) services that decrease substance-related harms, studies demonstrate that racial/ethnic minoritized people are less likely to have access to these services. They not only experience more negative consequences related to substance misuse but are also less likely to receive HR services or be retained in evidence-based treatment such as MAT. To tackle these unique problems, we created an integrated harm reduction intervention (IHRI) to be mobile and flexible to the needs of Black and Latinx PWUD. This culturally responsive IHRI will employ a HR care coordinator that can assess vulnerabilities in the social determinants of health (SDOH) and link people to needed services. Data from community partners who operate HR services and serve largely Black and Latinx PWUD suggests that participants who receive HR services have significant improvements in health and engagement. Yet, systemic barriers to additional social services NOT directly related to substance use persist, which often influence health outcomes and quality of life. Thus, offering a low barrier, geographically distributed, culturally informed HR intervention in historically excluded communities may prove a highly disseminable strategy, for improving access to HR services and MAT. We plan to evaluate the efficacy of this integrated HR intervention (by providing legal, housing and mental health treatment support, along with linkage to MAT) on participant retention and engagement of HR services among n=200 Black and Latinx PWUD compared to services as usual in two mobile Community Harm Reduction Organizations. The escalating overdose death rates among Black and Latinx PWUD is a serious public health. The focus on health disparities in addiction is of high priority to NIDA and may prove a useful model for decreasing harm and broadening MAT access for Black and Latinx PWUD, who have been historically excluded these services in traditional settings.