Vancouver Drug Users Study: Evaluating the Natural History of Injection Drug Use

 产品说明：本申请提出了新的调查注射药物使用的自然史，从开始到停止或死亡，以及发病率和死亡率的趋势的研究。我们建议在加拿大的温哥华开展这项工作，在那里，处方阿片类药物滥用的稳步增长已成为一个日益令人关切的问题。因此，我们还试图评估PO滥用对海洛因市场活跃环境中注射药物使用自然史的影响，包括PO使用对注射开始和停止、HIV风险行为和过量的影响。我们还旨在描述早期注射职业的特征，并确定影响注射开始、早期停止注射、持续注射和艾滋病毒风险行为的个人、社会结构和环境因素。专注于既定的注射，我们进一步的目标是描述个人，社会结构和环境因素，形状停止和复发注射，以及相关的发病率和死亡率。我们的项目涉及创建一个独特的队列，温哥华吸毒者研究（V-DUS，n = 1800），其中包括成年人注射毒品和非注射街头参与吸毒青年。参与者提供行为信息和生物标本，供我们的团队和其他NIDA调查人员进行测试，储存和使用。我们的多学科团队的成员有超过二十年的经验进行NIDA资助的队列为基础的研究，最近通过研究注射吸毒者参与温哥华注射吸毒者研究（VIDUS），这是世界上历史最悠久的注射吸毒者队列研究之一，和街头参与吸毒青年参与风险青年研究（阿里斯）。为了利用相当大的效率，学术和财政，我们建议合并阿里斯和VIDUS队列到温哥华吸毒者研究（V-DUS），使一个关键的额外五年的调查自然史注射吸毒。温哥华非常适合进行拟议的研究，原因有几个。这座城市是有史以来记录在案的注射吸毒者中最具爆炸性的艾滋病毒流行病之一的发源地，温哥华是非法药物的入境口岸，现在正在经历PO滥用流行病。此外，在不列颠哥伦比亚省的全民医疗保健计划下，我们能够将队列数据与各种行政数据库联系起来，允许评估医疗保险计划的混淆影响，我们建立的多学科团队和其他NIDA研究人员使用我们的队列平台在临床流行病学，社会，空间和基础科学领域开展各种工作，以及建模 成本效益研究。最后，温哥华一直是开发一系列IDU创新项目的所在地，因此我们计划利用这一队列基础设施来建立我们评估高度创新的IDU项目以及其他自然发生的事件的记录。通过这项工作，我们的目标是解决几个紧迫的全球健康挑战，并为制定旨在解决非法药物使用问题的政策和干预措施提供信息。

 DESCRIPTION: This application proposes novel investigations of the natural history of injection drug use, from initiation to cessation or death, as well as studies of trends in morbidity and mortality. We propose to undertake this work in Vancouver, Canada, where the steady growth in prescription opiate (PO) misuse has become a growing concern. Accordingly, we also seek to evaluate the impact of PO misuse on the natural history of injection drug use in an environment with an active heroin market, including the impact of PO use on injecting initiation and cessation, HIV risk behavior and overdose. We also aim to characterize early injecting careers and to identify the individual, social-structural and environmental factors that shape injecting initiation, early cessation of injecting, sustained injecting, and HIV risk behavior. Focusing on established injectors, we further aim to describe the individual, social-structural and environmental factors that shape cessation of and relapse into injecting, and associated morbidity and mortality. Our project involves the creation of a unique cohort, the Vancouver Drug Users Study (V-DUS, n = 1800), which involves adults who inject drugs and non-injecting street-involved drug-using youth. Participants provide behavioral information and biological specimens for testing, repository, and use by our team and other NIDA investigators. Members of our multidisciplinary team have more than two decades of experience conducting NIDA-funded cohort-based research, most recently through studies of IDU participating in the Vancouver Injection Drug Users Study (VIDUS), which is one of the longest-standing IDU cohort studies in the world, and street-involved drug-using youth participating in the At- Risk Youth Study (ARYS). In order to take advantage of considerable efficiencies, both academic and financial, we propose merging the ARYS and VIDUS cohorts into the Vancouver Drug Users Study (V-DUS), enabling a critical additional five years of investigation into the natural history f injection drug use. Vancouver is ideally suited for the proposed study for several reasons. The city was home to one of the most explosive HIV epidemics ever documented among IDU, and Vancouver is a port of entry for illicit drugs and is now experiencing a PO misuse epidemic. Further, under the province of British Columbia's universal healthcare plan, we are able to link cohort data to various administrative databases, permitting assessments of barriers to care that are free of the confounding effects of medical insurance schemes, and our established multidisciplinary team and other NIDA investigators use our cohort platform to undertake diverse work in the areas of clinical epidemiology, social, spatial, and basic science, as well as modeling and cost-effectiveness studies. Lastly, Vancouver has been the site of the development of a range of innovative programs for IDU and therefore we plan to use this cohort infrastructure to build on our track record of evaluating highly innovative programs for IDU, as well as other naturally occurring events. Through this work, we aim to address several urgent global health challenges and inform the development of policies and interventions that seek to address illicit drug use.