Characteristics and outcomes for hospitalized patients with methamphetamine and opioid co-use: Identifying opportunities for hospital-based addiction services tailored to co-use

项目总结/摘要 美国药物过量死亡人数持续上升，仅2021年就有超过10万人死亡。 甲基苯丙胺和阿片类药物的共同使用在很大程度上助长了最近的死亡率上升。此外，联合国- 2003年至2015年间，与使用相关的住院人数增加了五倍多。 以前的研究和基于医院的物质使用成瘾服务仅关注阿片类药物的使用。 这些成瘾医学服务增加了阿片类药物使用障碍的药物治疗率， 患者与继续门诊治疗的联系。因此，住院时间和再入院率 减少了。然而，过去的研究表明，具有共同使用的个体具有不同的社会人口统计学特征， 和健康状况，并且与使用阿片类药物的人相比， 单独使用阿片类药物现有的医院成瘾服务如何影响患者的证据有限， 共同使用甲基苯丙胺和阿片类药物或如何定制这些服务，以更好地治疗住院 患者共同使用。 这个Kirschstein-NRSA F30奖学金的总体目标是产生可以指导 医院成瘾药物治疗服务的最终开发、实施和评估 量身定制，共同使用。该提案的具体目标是：1）描述患者人口统计学特征， 来自全国代表性住院患者样本与合并用药相关的住院特征 住院，2）按物质量化出院后再次入院和死亡的风险 使用概况，以及是否因接受基于医院的成瘾服务而存在差异，以及3）识别 障碍和促进者，以提供基于医院的成瘾服务，为患者量身定制的共同使用。 拟议的混合方法项目是基于顺序解释方法。其中包括以下方面的培训 定量（目标1和2）和定性（目标3）研究方法。通过这项工作和 精心设计的培训计划，受训者将实现以下目标：1）发展卫生服务 研究专业知识，2）推进物质使用研究领域，因为它涉及多物质使用，3）整合 成瘾医学领域的研究、临床和宣传活动。这支持了他的长期目标， 连接卫生服务研究和临床医学，以支持物质使用障碍患者， 医生兼研究员

PROJECT SUMMARY/ABSTRACT Drug overdose deaths continue to rise in the United States, accounting for over 100,000 deaths in 2021 alone. Methamphetamine and opioid co-use are largely fueling the most recent increase in mortality. In addition, co- use associated hospital admissions increased more than five-fold between 2003 and 2015. Previous research and hospital-based addiction services for substance use have focused on opioid use alone. These addiction medicine services have increased rates of medication for opioid use disorder and improved patient linkage to continuing outpatient treatment. As a result, hospital length of stay and readmission rates have decreased. However, past research indicates individuals with co-use have different sociodemographic and health profiles and are less likely to receive medication for opioid use disorder than individuals who use opioids alone. There is limited evidence of how existing hospital-based addiction services effect patients who co-use methamphetamine and opioids or how these services could be tailored to better treat hospitalized patients with co-use. The overall objective of this Kirschstein-NRSA F30 fellowship is to generate evidence that can guide the eventual development, implementation, and evaluation of hospital addiction medicine treatment services tailored to co-use. The specific aims of this proposal are: 1) to characterize patient demographics and hospitalization characteristics associated with co-use from a nationally representative sample of inpatient hospitalizations, 2) to quantify the risk of re-admission and mortality following hospital discharge, by substance use profile, and whether differences vary by the receipt of hospital-based addiction services and 3) to identify barriers and facilitators to providing hospital-based addiction services tailored for patients with co-use. The proposed mixed methods project is based on a sequential explanatory approach. It includes training in both quantitative (Aims 1 & 2) and qualitative (Aim 3) research methodologies. Through this work and a thoughtfully designed training plan, the trainee will achieve the following goals: 1) develop health services research expertise, 2) advance the substance use research field as it relates to polysubstance use, 3) integrate research, clinical, and advocacy activities in the field of addiction medicine. This supports his long-term goal of bridging health services research and clinical medicine to support patients with substance use disorders as a physician-researcher.