A comparative evaluation of overdose prevention programs in New York City and Rhode Island

摘要 过去，美国已有100多万人死于意外服药过量 二十年了。为了应对这场有增无减的危机，纽约市实施了公众公认的前两项 全国服药过量预防中心(OPC)于2021年11月成立。罗德岛成为第一个 通过州立法授权诊所，预计将于2022年底开业。OPC是社区的- 基础设施，允许客户在监督下消费预先获得的受控物质 受过训练的人员，以便在服药过量时进行干预。OPC的工作人员也提供更安全的药物 消费教育，获得无菌药物使用用品，提供保健和辅助服务，并提供 转介至其他治疗、健康和康复服务。虽然来自其他国家和地区的研究 美国未经批准的网站显示，OPC产生个人健康和社区利益，没有评估 在美国存在被批准的OPC。这项拟议的研究具有极高的政策意义，它将 评估公共健康、公共安全和社区利益--以及潜在的意外影响-- 在美国受制裁的OPC。我们建议对OPC进行严格的、多地点、多组成部分的评估 2023-2027年在纽约市和罗德岛。在个人层面上，我们的目标是评估一个 在门诊就诊的500人的预期队列中，服药过量、其他健康问题的比率较低， 和急诊科使用，以及更高的物质使用障碍治疗启动率，与 没有参加门诊诊所的500人队列(目标1)。在社区层面，我们将研究是否 诊所周围的社区在吸毒过量方面变化较大，这是与毒品有关的公众的衡量标准 与未暴露的社区相比，诊所开业后的混乱和严峻的经济状况 至OPC(目标2)。第三，我们的目标是深入研究运营环境，包括邻居所扮演的角色 地点、计划模型和操作程序在塑造OPC使用的有效性方面起着作用 定性和人种学方法(目标3)。最后，我们将估计额外的成本和成本节约 与OPC使用相关的医疗保健和刑事司法系统，以支持未来的成本效益 分析OPC(目标4)。为了实现这些目标，我们召集了一家享誉国际的 调查团队，并建立了强大的、社区参与的减少危害研究伙伴关系 纽约市和罗德岛的组织。随着全美更多的司法管辖区考虑开放 OPC，这项拟议研究的结果将对美国的药物政策产生关键影响。该研究的结果 将对希望提供OPC、生成关键数据以优化 它们的有效性，并为这些干预措施的可持续性和扩大提供了模式。

ABSTRACT More than one million people have died from accidental drug overdose in the United States (US) in the past twenty years. In response to this unabating crisis, New York City implemented the first two publicly recognized overdose prevention centers (OPCs) in the nation in November 2021. Rhode Island became the first state to authorize OPCs through state legislation and they are expected to open in late 2022. OPCs are community- based facilities that permit clients to consume pre-obtained controlled substances under the supervision of personnel who are trained to intervene in the event of an overdose. Staff at OPCs also provide safer drug consumption education, access to sterile drug use supplies, offer health and ancillary services, and provide referrals to other treatment, health, and recovery services. While research from other countries and from an unsanctioned site in the US suggest that OPCs produce individual health and community benefits, no evaluations exist of sanctioned OPCs in the US. The proposed study has extraordinarily high policy significance, as it will evaluate the public health, public safety, and community benefits—and potential unintended effects—of the first sanctioned OPCs in the US. We propose to conduct a rigorous, multi-site, multi-component evaluation of OPCs in New York City and Rhode Island in 2023-2027. At the individual level, we aim to evaluate whether a prospective cohort of 500 persons attending OPCs experience lower rates of overdose, other health problems, and emergency department use, and a higher rate of substance use disorder treatment initiation, compared to a cohort of 500 persons who do not attend OPCs (Aim 1). At the community level, we will examine whether neighborhoods surrounding the OPCs experience a greater change in overdose, measures of drug-related public disorder, and acute economic conditions following the opening of OPCs, compared to neighborhoods unexposed to OPCs (Aim 2). Third, we aim to delve into the role that the operational context, including neighborhood location, program models, and operating procedures, plays in shaping the effectiveness of OPCs using qualitative and ethnographic approaches (Aim 3). Finally, we will estimate additional costs and cost savings to the healthcare and criminal justice systems associated with OPC use, to support future cost-effectiveness analyses of OPCs (Aim 4). To accomplish these aims, we have assembled an internationally renowned investigative team and established strong, community-engaged research partnerships with harm reduction organizations in New York City and Rhode Island. As more jurisdictions throughout the US consider opening OPCs, findings from the proposed research will have critical implications for US drug policy. The study’s results will have powerful, lasting implications for communities that wish to offer OPCs, generate critical data to optimize their effectiveness, and provide models for sustainability and expansion of these interventions.