Understanding the short- and long-term effects of the COVID-19 pandemic on the overdose crisis

在新冠肺炎大流行期间，吸毒过量急剧上升，突显出迫切需要了解 灾害对过量用药的影响。我们需要进行研究，以确定可以防止 在未来的灾难中，服药过量的情况也会出现类似的增加。我们还需要了解为什么某些社区 特别容易在灾难发生期间和之后经历服药过量的上升，所以我们可以最好地 有针对性地开展预防和救灾工作。我们建议使用重大事件理论作为框架来：1) 研究新冠肺炎疫情及其对服药过量和相关后果的影响；2)确定政策应对措施 到新冠肺炎，这影响了个人层面的服药过量风险；以及3)检查大流行对 服药过量的风险因社区和人群而异。我们假设新冠肺炎遏制住了 政策(如关闭工作场所)助长了社会孤立，增加了单独吸食毒品的风险 以及限制获得治疗和减少伤害服务，从而增加服药过量的风险。相比之下，公共的 健康(例如，实得的美沙酮豁免)和对新冠肺炎的经济支持政策回应(例如， 住房驱逐暂停)可能使吸毒者更容易获得医疗服务(PWUD)和 缓解了大流行带来的经济困难，通过以下途径阻断了卫生和经济途径 大流行可能会增加服药过量的风险。我们假设，具有更多结构性的社区 绝望的根源(例如，高失业率、贫困)，以及那些同时经历其他 重大社会危机(自然灾害、政治冲突、大规模枪击)更容易受到影响 新冠肺炎因服药过量。相比之下，在大流行之前制定的社会和经济政策是为了保护 弱势群体(例如，较高的州医疗补助收入门槛)可能已经减少了 关于吸毒过量风险的大流行。我们的目标是：(1)确定个人在当地的过量用药风险 (总体和按种族/族裔划分)在县级提升新冠肺炎健康水平后，2019-2025年发生了变化 负担(住院、死亡)。(2)确定针对新冠肺炎的县州两级政策 大流行期间的感染控制、残障人士的公共卫生和经济支持 县级新冠肺炎负担变化与服药过量发生率、总体和死亡率变化的关系 按种族/民族分类。(3)确定哪些社区条件影响了关系的强度 在县级新冠肺炎负担变化和个人服药过量风险之间，总体上和按种族/族裔划分， 包括：a)先前存在的社区结构特征(例如贫困率)；b)先前存在的政策，以 保护弱势群体(例如，州医疗补助计划收入门槛)；以及c)交叉危机。我们 将在全国六个PCORnet®网络中建立一个由约240万名18岁以上患者组成的多中心队列 追踪社区新冠肺炎负担对个体服药过量风险的影响。我们的研究结果将告诉我们 应对当前的吸毒过量危机和未来的灾难。

Overdose has risen sharply during the COVID-19 pandemic, highlighting an urgent need to understand the impact of disasters on overdose. We need research to identify the types of policy measures that can prevent a similar increase in overdose in future disasters. We also need to understand why certain communities are particularly vulnerable to experiencing rises in overdose during and after a disaster, so that we can optimally target prevention and disaster response efforts. We propose to use Big Events Theory as a framework to: 1) study the COVID-19 pandemic and its effects on overdose and related outcomes; 2) identify policy responses to COVID-19 that affected individual-level overdose risk; and 3) examine how the pandemic's impact on overdose risk varied across communities and populations. We hypothesize that COVID-19 containment policies (e.g., workplace closings) contributed to social isolation, increasing the risk of consuming drugs alone and limiting access to treatment and harm reduction services, thus increasing overdose risk. In contrast, public health (e.g., take-home methadone waivers) and economic support policy responses to COVID-19 (e.g., housing eviction moratoria) may have eased access to health services for people who use drugs (PWUD) and alleviated economic difficulties arising from the pandemic, blocking health and economic pathways through which the pandemic could increase overdose risk. We hypothesize that communities with more structural sources of despair (e.g., high rates of unemployment, poverty), and those that concurrently experienced other major societal crises (natural disasters, political conflict, mass shootings) were more vulnerable to the effects of COVID-19 on overdose. In contrast, social and economic policies enacted before the pandemic to protect vulnerable populations (e.g., higher state Medicaid income threshold) may have reduced the impact of the pandemic on overdose risk. Our Aims are to: (1) Determine how individual overdose risk in localities (overall and by race/ethnicity) changed over 2019–2025 after county-level elevations in COVID-19 health burden (hospitalizations, deaths). (2) Determine which county- and state-level policies targeting COVID-19 infection containment, public health of PWUDs, and economic support during the pandemic mediated relations between changes in county-level COVID-19 burden and changes in overdose incidence, overall and by race/ethnicity. (3) Identify which community conditions affected the strength of the relationships between changes in county-level COVID-19 burden and individual overdose risk, overall and by race/ethnicity, including: a) pre-existing community structural characteristics (e.g., poverty rate); b) pre-existing policies to protect vulnerable populations (e.g., state Medicaid program income threshold); and c) intersecting crises. We will build a multi-center cohort of ~2.4 million patients aged 18+ in six PCORnet® networks across the country to track the impact of community COVID-19 burden on individual overdose risk. Our study findings will inform the response to the current overdose crisis and to future disasters.