The Rhode Island Young Adult Prescription and Illicit Drug Study (RAPIDS): Responding to Fentanyl and Associated Harms

项目摘要 美国正在经历历史上最严重的药物过量流行病。这场危机已经大大 由于强效合成阿片类药物，特别是芬太尼和相关类似物的出现而加剧。芬太尼 现在是海洛因中最常见的掺假物，已被发现在假冒处方药和非法药物中。 可卡因等毒品。只有少量的芬太尼（相当于几粒盐）可以导致 过量致死因此，它在非法药物供应中的存在对那些不知情地消费它的人构成了巨大的风险。 的实质。在美国，超过30%的药物过量死亡是由于合成阿片类药物（主要是芬太尼）， 然而，很少有旨在降低芬太尼过量风险的策略已经被开发出来。采用随机 对照试验，我们将测试一种新的，基于理论的芬太尼过量教育和咨询的疗效 干预措施包括“带回家”快速芬太尼测试条，以减少过量服用率。研究 将在罗得岛进行，该州是全国吸毒过量率第十大州， 半数与毒品有关的死亡是芬太尼造成的。我们将在社区招募500名年轻人 18至35岁使用海洛因或非法兴奋剂、假冒处方药或注射毒品者。在 干预组，个人将参加急流干预，一种新的芬太尼过量教育 和咨询计划，提供有关芬太尼的危险信息，动机采访， 增加使用快速芬太尼试纸的意愿，并参与减少伤害的行为，动手 关于如何使用条带的培训，以及讨论和角色扮演如何实施危害减少的机会 行为。随机分配至对照组的个体将接受标准过量教育和纳洛酮 分布主要结局将是12个月随访期间观察到的自我报告过量的发生率- 上时期。我们将使用致死性和非致死性用药过量事件的数据补充主要终点 通过疾病预防控制中心资助的全州药物过量监测系统确定。本研究的具体目的 1）评估急流干预措施在降低年轻人过量服用率方面的有效性， 使用药物; 2）检查药物过量率的降低在多大程度上是由药物过量率的增加介导的。 信息，动机，行为技能和自我效能有关芬太尼，快速芬太尼测试和危害 减少实践;和3）探索是否存在与关键参与者相关的治疗效果异质性 特色我们的研究非常重要，因为它直接解决了如何 最好的减少风险的过量年轻人在面对不断升级的芬太尼流行病。这项研究是 这是一项极具创新性的研究，因为它将是美国第一个测试一种新型过量药物疗效的研究。 教育和咨询干预，包括带回家的快速检测技术，以检测暴露 与芬太尼之间的联系总之，这项研究的结果将显着 加强公共卫生工作，防止年轻人吸毒过量。

PROJECT SUMMARY The United States is experiencing the worst drug overdose epidemic in history. This crisis has been greatly exacerbated by the emergence of potent synthetic opioids, particularly fentanyl and related analogs. Fentanyl is now the most common adulterant in heroin and has been identified in counterfeit prescription pills and illicit drugs such as cocaine. Only a small amount of fentanyl (the equivalent of several grains of salt) can lead to a fatal overdose. Its presence in the illicit drug supply thus poses great risk to those who unknowingly consume the substance. Over 30% of all drug overdose deaths in the US are due to synthetic opioids (mostly fentanyl), yet few strategies aimed at reducing risk of fentanyl overdose have been developed. In this randomized controlled trial, we will test the efficacy of a novel, theory-based fentanyl overdose education and counseling intervention that incorporates “take-home” rapid fentanyl testing strips in reducing rates of overdose. The study will be conducted in Rhode Island, a state with the tenth highest overdose rate in the nation and in which over half of drug-related deaths are due to fentanyl. We will recruit a community-based sample of 500 young adults aged 18 to 35 who use heroin or illicit stimulants, counterfeit prescription pills, or inject drugs. In the intervention arm, individuals will participate in the RAPIDS intervention, a novel fentanyl overdose education and counseling program that provides information about the dangers of fentanyl, motivational interviewing to increase willingness to use rapid fentanyl test strips and engage in harm reduction behaviors, hands-on training on how to use the strips, and opportunities to discuss and role-play how to implement harm reduction behaviors. Individuals randomized to the control arm will receive standard overdose education and naloxone distribution. The primary outcome will be the rate of self-reported overdose observed over the 12-month follow- up period. We will supplement the primary endpoint with data on fatal and non-fatal overdose events ascertained through a CDC-funded statewide overdose surveillance system. The Specific Aims of this study are to: 1) Assess efficacy of the RAPIDS intervention in reducing rates of overdose among young adults who use drugs; 2) Examine the degree to which reductions in rates of overdose are mediated by increases in information, motivation, behavioral skills, and self-efficacy regarding fentanyl, rapid fentanyl testing, and harm reduction practices; and 3) Explore whether there is heterogeneity of treatment effect related to key participant characteristics. Our study is highly significant because it directly addresses crucial knowledge gaps in how to best reduce risk of overdose among young adults in the face of an escalating fentanyl epidemic. The study is highly innovative because it will be the first in the United States to test the efficacy of a novel overdose education and counseling intervention that incorporates take-home rapid testing technology to detect exposure to fentanyl in a population of people who use drugs. In sum, the results of this research will significantly enhance public health efforts to prevent overdose among young adults.