Integrating responses to stimulant overdose among post-overdose programs

项目总结/摘要 虽然芬太尼和芬太尼类似物是美国阿片类药物过量的主要驱动因素，但可卡因和 其他兴奋剂，如甲基苯丙胺，越来越多地出现在阿片类药物和非阿片类药物过量的情况下。 死亡这些与兴奋剂有关的过量死亡现在是"不断发展的过量流行病"或第四大流行病的核心。 吸毒过量危机的浪潮由于黑人、拉丁裔和土著人在医疗保健系统中面临不平等， 较低的物质使用治疗，他们不成比例地受到这种涉及兴奋剂的影响 波此外，在年轻人中，现在有更多的多物质涉及过量死亡，而不仅仅是阿片类药物 死亡过量用药后的外展计划已成为一个重要的和日益增长的反应过量 通过对过量用药幸存者提供及时的随访， 健康和公共安全团队。随着人们逐渐认识到可卡因等兴奋剂的作用， 甲基苯丙胺，过量预防计划保证适应和加强，以解决兴奋剂 使用、使用障碍和过量风险。有机会利用这些方案来发展和 采用兴奋剂使用的变通办法，提供减少风险教育和与兴奋剂有关的 过量预防和与治疗的联系。在这个基础设施内工作，与现有的后- 过量计划，我们建议开发一个工具包的战略，以减少兴奋剂相关的死亡。中的每 这些调整将专门针对有色人种（黑人、拉丁裔和土著人）， 青年我们的具体目标是：（1）开发和实施一个适应过量后外展的工具包 计划解决兴奋剂使用和兴奋剂过量的整体和人的颜色和青年;（2） 对适应方案进行过程评估，以解决方案中兴奋剂的使用问题;以及（3）确定 调整工具包的有效性：（a）增加与兴奋剂使用者的接触，（B）减少 兴奋剂危险行为，和（c）增加对兴奋剂使用障碍的治疗机会， 有色人种和年轻人。马萨诸塞州提供了一个数据丰富的环境，以确定后， 过量服用兴奋剂的外展在以社区为基础的参与性研究原则的指导下，我们 将整合适应性创新，以解决从马萨诸塞州项目中学到的兴奋剂问题，并利用这一点， 提供信息，以指导和宣传兴奋剂过量预防的设计和传播， 全国各地的社区。拟议的研究将解决目标1，如 资金机会的通知。

Project Summary/Abstract While fentanyl and fentanyl analogues are the main drivers opioid overdoses in the United States, cocaine and other stimulants, like methamphetamine, are increasingly present in both opioid and non-opioid overdose deaths. These stimulant-involved overdose deaths are now central to the “evolving overdose epidemic” or 4th wave of the overdose crisis. As Black, Latinx, and Native people face inequities in the health care system and lower access to substance use treatment, they are disproportionately affected by this stimulant-involved 4th wave. In addition, among youth, there are now more polysubstance involved overdose deaths than opioid only deaths. Post-overdose outreach programs have emerged as an important and growing response to overdose deaths by providing timely follow-up to overdose survivors and are often collaboratively implemented by public health and public safety teams. With the emerging recognition of the role of stimulants, like cocaine and methamphetamine, overdose prevention programs warrant adaptation and enhancement to address stimulant use, use disorders, and overdose risks. There is an opportunity to leverage these programs to develop and introduce adaptations for stimulant use that will provide risk reduction education and stimulant-related overdose prevention and linkage to treatment. Working within this infrastructure to partner with existing post- overdose programs, we propose to develop a toolkit of strategies to reduce stimulant-involved deaths. Each of these adaptations will be tailored to specifically engage people of color (Black, Latinx, and Native people) and youth. Our specific aims are to: (1) develop and implement a toolkit of adaptations for post-overdose outreach programs to address stimulant use and stimulant overdose overall and among people of color and youth; (2) conduct a process evaluation of the adaptations to address stimulant use in programs; and (3) determine the effectiveness of the toolkit of adaptations to: (a) increase contact with people who use stimulants, (b) reduce stimulant risk behaviors, and (c) increase treatment access for stimulant use disorder overall and among people of color and youth. Massachusetts provides a data-rich environment to ascertain the impact of post- overdose outreach on stimulant overdose. Guided by principles of community-based participatory research, we will integrate adaptive innovations to address stimulants learned from Massachusetts programs and use this information to guide and inform the design and dissemination of stimulant overdose prevention in communities across the country. The proposed research will address Objective 1, as described in the Notice of Funding Opportunity.