Navigating the Fentanyl Age with Community Drug Checking

项目摘要 毒品供应是在巨大的流动与非法制造芬太尼（国际货币基金组织）和类似物创造一个致命的 毒品使用者环境（PWUD）。IMF在2020年声称有93，311人死亡，是 目前的危机。它发病迅速，几乎没有时间进行紧急干预， 阿片类药物的流通破坏了循证治疗。罗得岛（RI）是早期国际货币基金组织（IMF）的所在地 灾难，关于IMF的流行病学调查的主题，以及扩大的创新中心 获得拯救生命的纳洛酮和阿片类药物使用障碍（MOUD）的药物，以及更好地提供 他们最近的两项创新即使在国际货币基金组织的地方性和COVID-19大流行的情况下也显示出希望，因为 他们解决了非法药物供应的正面：非传统的MOUD诱导途径和社区药物 正在检查但是，除非我们学会如何导航，否则非法药物供应可能会破坏治疗的成功 了一种新的方法是社区药物检查。药物检查可以深入了解 人们使用的药物，让PWUD参与相关的健康信息交换，并生成可以 告知治疗。将这些数据应用于流行病学研究，以帮助更好地了解接触情况， 识别风险、测量后果并考虑它们在临床环境中作用以告知治疗， 没有被检查。我们提出了一项观察性研究，利用最近获得的设备和能力 开展药物检查，多个人水平数据集，国家法律和公共研究 卫生领导支持药物检查。与RFA一致，我们寻求揭示特征如何 国际货币基金组织在药物供应中的作用有意地影响治疗方案和持续的药物使用以及人们的风险 或无意中使用多物质（主题2和4）。具体目标是：目标1）检查解剖的 通过建立社区毒品检查队列（n=600），了解如何：a）货币基金组织的存在， 形式（即，粉末、假药）和阿片类药物供应的效力影响持续使用和过量风险; B） IMF在兴奋剂等非阿片类药物中的存在会影响使用，过量风险和临床健康严重程度 后果;和c）使用药物检查影响MOUD的摄取。[UG3 UH3）。目标2）文件 临床医生对药物检查的看法，以及他们的经验，创新，障碍和促进者， 诱导患者接受MOUD，包括RI中的微量和大量给药。[UH3]目标3）评估 社区药物检查队列成员a）哪些药物供应特征与正在进行的 药物使用、过量和MOUD兴趣; B）哪些药物供应因素影响诱导问题的发生率 例如使用管理数据的丁丙诺啡治疗中的突然停药和成功保留。[UH3] 调查结果将有助于为IMF流行地区的药物供应提供预防和干预方法， 确定社区药物检查的参与和临床效用，并帮助确定影响因素 治疗经验差，保留更好。

Project Summary The drug supply is in enormous flux with illicitly manufactured fentanyl (IMF) and analogs creating a deadly environment for people who use drugs (PWUD). Claiming 93,311 lives in 2020, IMF is the underlying driver of the current crisis. Its fast onset leaves little time for emergency intervention and its presence as the dominant opioid in circulation undermines evidence-based treatments. Rhode Island (RI) is a site of early IMF devastation, subject of much epidemiologic investigation about IMF, and an innovation hub for expanded access to lifesaving naloxone and medications for opioid use disorder (MOUD) and structures to better provide them. Two recent innovations show promise even with IMF’s endemicity and the COVID-19 pandemic because they address the illicit drug supply head-on: non-traditional MOUD induction pathways and community drug checking. But treatment success may be undermined by the illicit drug supply unless we learn how to navigate it. One novel approach to doing so is with community drug checking. Drug checking gives insights into what drugs people use, engages PWUD in relevant exchange of health information, and generates data that could inform treatment. Application of these data for epidemiologic research to help better understand exposure, identify risk, measure consequence and consideration of their role in a clinical setting to inform treatment have not been examined. We propose an observational study that leverages recently acquired devices and capacities to carry out research on drug checking, multiple linkable individual level datasets, and state law and public health leadership supportive of drug checking. Consistent with the RFA, we seek to uncover how characteristics of IMF in the drug supply influence treatment regimens and ongoing drug use and risk in people intentionally or unwittingly using polysubstances (topics 2 and 4). Specific aims are to: Aim 1) Examine the anatomy of the illicit drug supply by establishing a community drug checking cohort (n=600) to learn how: a) IMF’s presence, form (i.e., powder, counterfeit pill), and potency in the opioid supply affect ongoing use and overdose risk; b) IMF’s presence in non-opioid drugs like stimulants affects use, overdose risk and clinical severity of health consequences; and c) use of drug checking affects uptake of MOUD. [UG3 and UH3]. Aim 2) Document clinicians’ perceptions about drug checking, and their experiences, innovations, barriers and facilitators of induction of patients onto MOUD, including micro- and macro-dosing, in RI. [UH3] Aim 3) Assess among community drug checking cohort members a) which drug supply characteristics are associated with ongoing drug use, overdose and MOUD interest; b) what drug supply factors impact incidence of induction problems like precipitated withdrawal and successful retention in buprenorphine care using administrative data. [UH3] Findings will help inform prevention and intervention approaches to the drug supply in IMF endemic areas, determine engagement in and clinical utility of community drug checking, and help identify factors influencing poor treatment experience and better retention.