Examining the Impact of the Twin Epidemics of Methamphetamine and Opioid Use on Overdose, Risky Sex and Treatment Engagement among PWUD in Two Rural Appalachian Cohorts

摘要 本次R 01更新的目的是检查甲基苯丙胺（MA）使用对致命和非致命性 过量，从事注射和性风险行为，以及阿片类药物使用障碍（OUD）的治疗， 来自两个阿巴拉契亚队列的吸毒者（PWUD）中的其他物质使用障碍（SUD）。 使用阿片类药物的人中MA的使用正在增加。最近的一些出版物已经创造了这种增长， 甲基苯丙胺/类阿片合并使用是“孪生流行病”，因为一些地区报告了新的甲基苯丙胺使用 尤其是受到阿片类药物流行的严重打击。该应用程序建立在两项已建立的队列研究的基础上 位于阿片类药物危机的中心-阿巴拉契亚人之间的社交网络（SNAP）队列 GATEWAY2HOPE（G2H）这些队列将合并，以扩大地理范围， 1）确定甲基苯丙胺使用的特征， 继续使用阿片类药物（孪生流行病），开始使用冰毒，以及PWUM的社交网络。基础上 我们已经收集了阿片类药物使用随时间推移的数据，将在开始时收集额外的前瞻性数据， 甲基苯丙胺的使用模式，包括给药途径; 2）检查 性和注射风险行为作为开始使用冰毒的结果。为此目的采取的具体措施包括： 非致命性过量、共用注射器和其他注射用具以及无保护的性行为 遭遇将进行艾滋病毒、丙型肝炎病毒和性传播感染检测以及死亡证明审查， 自我报告的行为数据; 3）确定MA使用对SUD/OUD治疗寻求、治疗 启动和长期参与SUD治疗。虽然迄今为止从SNAP收集的数据和 CARE 2 HOPE队列在告知阿巴拉契亚农村阿片类药物流行方面非常宝贵， 这一更新将填补文献中的额外空白。目前，关于这方面的信息很少。 “孪生流行病”现象及其对致命和非致命过量的潜在影响， 特别是在资源匮乏的地区，如阿巴拉契亚农村地区。的 拟议的更新将填补这些空白，并提供解决毒品相关危害所不可或缺的数据 在美国农村

ABSTRACT The goal of this R01 renewal is to examine the impact of methamphetamine (MA) use on fatal and nonfatal overdose, engagement in injection- and sex-risk behaviors, and treatment for opioid use disorder (OUD) and other substance use disorders (SUD) among people who use drugs (PWUD) from two Appalachian cohorts. MA use among people who use opioids is increasing. Several recent publications have coined this increase in MA/opioid co-usage as the “twin epidemics”, as new onset methamphetamine use has been reported in areas particularly hard hit by the opioid epidemic. This application builds on work from two established cohort studies located in the epicenter of the opioid crisis - the Social Networks Among Appalachian People (SNAP) cohort and GATEWAY2HOPE (G2H). These cohorts will be combined to increase both geographic scope and statistical power and to examine the following aims: 1) To characterize use of methamphetamine in the context of continued opioid use (twin epidemics), initiation of meth use, and social networks of PWUM. Building on the data we have gathered for opioid use over time, additional prospective data will be collected on initiation and use patterns for methamphetamine, including route of administration; 2) To examine longitudinal changes in sex- and injection-risk behaviors as a result of initiation of meth use. Measures specific to this aim include fatal and non-fatal overdose, sharing of syringe and other injection paraphernalia, and unprotected sexual encounters. HIV, HCV and STI testing, as well as death certificate reviews will be conducted to complement self-reported behavioral data; and 3) determine impact of MA use on SUD/OUD treatment seeking, treatment initiation and long-term engagement in SUD treatment. While the data collected to date from the SNAP and CARE2HOPE cohorts have been invaluable in informing the opioid epidemic in rural Appalachia, it is important that this renewal be positioned to fill additional gaps in the literature. Currently, there is little information on the “twin epidemic” phenomenon and its potential impact on fatal and non-fatal overdoses, the SUD treatment cascade, and harm reduction services, especially in resource-deprived areas such as rural Appalachia. The proposed renewal will address these gaps and provide data that are integral to addressing drug-related harms in the rural U.S.