CE23-002 - Assessing the Impact of Overdose Prevention Centers as a Polysubstance Use and Behavioral Health Intervention in New York City

项目摘要/摘要 在美国，吸毒过量的流行势头有增无减。药品供应的变化和 与兴奋剂有关的过量死亡已经将阿片类药物过量流行转变为一种多物质 吸毒过量流行。现在全国超过一半的过量死亡涉及多种物质，导致一些 研究人员将当前的多物质时代确定为疫情的“第四波”。多物质的增加 使用(PSU)和PSU过量给从业者和研究人员带来了一系列挑战。知道 新出现的减害干预措施是否以及在多大程度上可以降低PSU涉及的过量用药风险 对公共卫生当局和服务提供者来说至关重要。吸毒过量预防中心(OPC)、社区- 个人在训练有素的监督下消费预先获得的受控物质的基础设施 可以在服药过量的情况下进行干预的工作人员就是这样一种干预。超过200家OPC在全球运营，但 美国首批两家公认的OPC于2021年在纽约市开业。其他地区的OPC 各国的致命性和非致命性过量用药风险降低，急救服务减少。 利用率。然而，先前的研究还没有评估OPC的使用对PSU中过量用药风险的影响。 涉及到的人群。此外，并发的精神健康障碍仍然是一个严重但未被发现的风险。 PSU过量和其他危害的因素，然而到目前为止的研究还没有评估OPC之间的联系 使用和心理健康结果，尽管估计表明在 OPC客户端。因此，K01提案的目标是解决这些关键的研究差距：(1)确定 OPC使用对参与PSU的个体中非致命性和致命性过量风险的异质性影响；(2) 评估OPC的使用对PSU患者中治疗的精神事件的影响；以及(3)评估需求 减少伤害提供者将精神健康服务纳入现有的注射器服务和OPC交付 模型，特别侧重于PSU相关人群的需求。这项研究计划得到了一个 卓越的导师团队和培训计划。拟议的项目以候选人的背景为基础 物质使用流行病学和数据科学，在几个领域提供新的培训：(1)新的统计 在PSU中使用OPC对过量用药风险的异质性治疗效果的识别方法 涉及个人；(2)精神流行病学和心理健康之间的复杂关系， 物质使用障碍和PSU；以及(3)概念化和评估小说的实施科学 针对PSU相关人群的综合行为保健模式。研究与训练相结合 计划将使候选人能够过渡到与政策相关的社会和 形成过量用药风险的行为因素。这项研究与疾控中心的药物过量预防研究一致 在社会生态的多个层面上确定PSU过量风险和保护因素的优先事项。

PROJECT SUMMARY/ABSTRACT The overdose epidemic continues unabated in the United States. Changes to the drug supply and increases in stimulant-involved overdose deaths have shifted what was an opioid overdose epidemic to a polysubstance overdose epidemic. Over half of overdose deaths nationally now involve multiple substances, leading some researchers to identify the current polysubstance era as the epidemic’s “fourth wave.” Increases in polysubstance use (PSU) and PSU overdose pose a host of challenges for practitioners and researchers to address. Knowing whether and to what extent emerging harm reduction interventions can reduce PSU-involved overdose risk is critical for public health authorities and service providers. Overdose prevention centers (OPCs), community- based facilities at which individuals consume pre-obtained controlled substances under the supervision of trained staff who can intervene in event of an overdose, are one such intervention. Over 200 OPCs operate globally, but the first two publicly recognized OPCs in the United States opened in New York City in 2021. OPCs in other countries are associated with reduced fatal and non-fatal overdose risk and reduced emergency service utilization. However, prior research has not assessed the impact of OPC use on overdose risk among PSU- involved populations. In addition, concurrent mental health disorders remain a critical yet underexplored risk factor for PSU overdose and other harms, yet studies to date have not assessed the association between OPC use and mental health outcomes, despite estimates suggesting a high untreated mental health burden among OPC clients. As such, the objective of this K01 proposal is to address these critical research gaps to: (1) identify heterogeneous impacts of OPC use on non-fatal and fatal overdose risk among individuals engaging in PSU; (2) estimate the impact of OPC use on treated psychiatric events among clients with PSU; and (3) assess the needs of harm reduction providers to integrate mental health services into existing syringe service and OPC delivery models, with a particular focus on the needs of PSU-involved populations. The research plan is bolstered by an exceptional mentorship team and training plan. The proposed project builds on the candidate’s background in substance use epidemiology and data science and provides new training in several areas: (1) novel statistical methods for the identification of heterogeneous treatment effects of OPC use on overdose risk among PSU- involved individuals; (2) psychiatric epidemiology and the complex relationship between mental health, substance use disorders, and PSU; and (3) implementation science to conceptualize and evaluate novel integrated behavioral health care models for PSU-involved populations. The combined research and training plan will enable the candidate to transition into an independent researcher of policy-relevant social and behavioral factors that shape overdose risk. This research aligns with CDC’s Overdose Prevention Research Priorities to identify PSU overdose risk and protective factors across multiple levels of the social ecology.