An ethno-epidemiological study of the implementation and effectiveness of an innovative and comprehensive response to the opioid epidemic

项目总结/摘要 北美的阿片类药物流行是发病率和死亡率的主要驱动因素，与阿片类药物有关的过量 成为意外死亡和阿片类药物注射驱动艾滋病毒和丙型肝炎（HCV）爆发的主要原因。 到目前为止，还缺乏对个人和个人以外的人对执行的影响的研究 以及全面和创新应对类阿片流行病的有效性。因此， 缺乏对如何优化对阿片类药物流行病的反应的理解，以及 联合干预措施是减少阿片类药物相关危害的最有效措施。总部设在温哥华， 加拿大，拟议的研究将采用创新的民族流行病学方法，探讨：（1） 以类阿片为重点的创新和全面干预措施的实施情况及其对类阿片相关 结果;（2）在阿片类药物使用管理中纳入循证实践的影响 （3）社会、结构和 环境对获得和保留循证治疗的影响，以及对 阿片类药物相关的结果。作为北美对阿片类药物最全面的反应之一， 由于流行病，温哥华是进行拟议研究的理想场所。温哥华已经实施了 目前正在考虑的以阿片类药物为重点的创新干预措施-但尚未实施- 在美国和加拿大的其他地方，包括：监督注射服务;低阈值阿片类激动剂 治疗;阿片类药物维持治疗;以及芬太尼类药物检查和监测服务。此外，本发明还 当地开发的OUD管理临床实践指南（最近在JAMA上进行了概述）正在 在急性、住院和社区护理环境中实施，同时对医疗保健进行其他改革 系统，包括系统地将以类阿片为重点的治疗和减少危害方案纳入 医院设置。拟议的研究将嵌套在不列颠哥伦比亚省的研究基础设施内 艾滋病毒/艾滋病卓越中心，其中包括三项由NIDA资助的纵向队列研究，包括 使用阿片类药物的PWUD（HIV阴性和HIV阳性）和使用毒品的街头青年（SY），并与 外部健康和空间数据。因此，这种方法提供了一个“增值”的机会，利用这些群体 进行流行病学和空间信息采样和有针对性地招募PWUD的研究， SY并收集定性数据，这些数据可以与基于队列的数据和外部数据进行三角测量。扩大我们的民族- 流行病学研究，以检查这种全面的反应，阿片类药物流行病将导致更多的 全面了解对以阿片类药物为重点的干预措施的影响，而不是通过流行病学 独自研究。拟议的研究符合NIDA战略计划（2016-2021），并将产生 这些证据对于优化和扩大阿片类流行病应对措施至关重要。

PROJECT SUMMARY/ABSTRACT North America’s opioid epidemic is a major driver of morbidity and mortality, with opioid-related overdoses becoming the leading cause of accidental death and opioid injecting driving HIV and hepatitis C (HCV) outbreaks. To date, there has been a lack of research into individual and extra-individual influences on the implementation and effectiveness of comprehensive and innovative responses to the opioid epidemic. As a consequence, there is a lack of understanding regarding how to optimize the response to the opioid epidemic, as well as the combination of interventions that are most effective in reducing opioid-related harms. Based in Vancouver, Canada, the proposed research will employ an innovative ethno-epidemiological approach to explore: (1) the implementation of innovative and comprehensive opioid-focused interventions and their impact on opioid-related outcomes; (2) the impact of the integration of evidence-based practices in the management of opioid use disorders (OUD) across the continuum of care on addiction treatment outcomes; and, (3) social, structural, and environmental influences on access to and retention in evidence-based treatment, and the onward impact on opioid-related outcomes. As the site of one of North America’s most comprehensive responses to the opioid epidemic, Vancouver is the ideal setting to undertake the proposed research. Vancouver has implemented innovative opioid-focused interventions that are currently being considered – but are not yet available – elsewhere in the US and Canada, including: supervised injection services; low-threshold opioid agonist therapies; opioid maintenance therapy; and, fentanyl-based drug checking and monitoring services. Additionally, locally-developed clinical practice guidelines for the management of OUD (recently profiled in JAMA) are being implemented across acute, residential, and community care settings alongside other changes to the healthcare system, including the systematic integration of opioid-focused treatment and harm reduction programming into hospital settings. The proposed study will be nested within the research infrastructure of the British Columbia Centre for Excellence in HIV/AIDS, which includes three NIDA-funded, longitudinal cohort studies that include opioid-using PWUD (HIV-negative and HIV-positive) and drug-using street-involved youth (SY) and are linked to external health and spatial data. Thus, this approach offers a ‘value-added’ opportunity to harness these cohort studies to undertake epidemiologically and spatially-informed sampling and targeted recruitment of PWUD and SY and collect qualitative data that can be triangulated with cohort-based and external data. Extending our ethno- epidemiological research to examine this comprehensive response to the opioid epidemic will result in a more complete understanding of influences on opioid-focused interventions than is possible through epidemiological research alone. The proposed research is aligned with the NIDA Strategic Plan (2016-2021), and will generate evidence that will be critical to informing the optimization and scale-up of the response to the opioid epidemic.