Mechanisms Linking Nonmedical Prescription Drug Use and Injection Drug Use

此R01应用程序通过调查将非医疗处方药使用(NMPD)与注射用药(IDU)联系起来的机制来响应NIDA PA08-127？处方药滥用？一个中心焦点也是这些关系如何根据艾滋病毒状况和艾滋病毒危险行为的不同而不同。大多数关于NMPD的研究要么招募了不包括注射吸毒者的样本，要么没有将他们作为一个单独的群体进行检查。缺乏对注射吸毒者独特需求的关注可能会阻碍临床和公共卫生努力的进展，以预防、识别和治疗NMPD，并有效地解决注射吸毒者中的艾滋病毒危险行为和健康问题。设计和实施NMPD干预措施的一个关键障碍是，非医疗用途一词涵盖了一系列不同的使用动机。NMPD的这些动机可以大致归类为快感(例如，将非法药物和处方药结合起来以获得更好的效果)和自我治疗(例如，在没有合法处方的情况下使用以缓解身体疼痛、负面情绪或停药)。此外，根据使用的基本动机，在采购处方药时使用的来源(例如，卫生诊所、急诊科、药房、朋友)和机制(例如，盗窃、共享)可能存在重要差异。以前的工作通常将多种动机组合成一个单一的NMPD类别。因此，需要进行创新研究，例如针对像注射吸毒者这样的大容量消费者的研究，根据使用动机将NMPD分解为亚型。关于NMPD动机亚型和相关特征的信息(例如，发病顺序、消费和获得的模式和预测因素)是未来研究的重要领域，因为用于自我治疗的患者可能需要与用于欣快症的患者不同的干预策略。通过有针对性的抽样，我们将在旧金山招募750名注射吸毒者，并在基线评估中收集生活史数据，并进行为期6个月的随访：目标1：评估注射吸毒者和NMPD的生活方式和当前消费行为的模式，以及与艾滋病毒状况和艾滋病毒危险行为的差异；目标2：检查生物、心理和社会背景特征对NMPD和NMPD动机亚型的影响；目标3：表征NMPD的来源、机制和感知获得途径，并按NMPD的动机亚型检查差异；目标4：说明获得保健服务(例如，药物滥用治疗、艾滋病毒护理)如何影响消费模式和转移做法。

This R01 application responds to NIDA PA08-127 ¿Prescription Drug Misuse¿ by investigating the mechanisms linking non-medical prescription drug use (NMPD) with injection drug use (IDU). A central focus is also how these relations differ by HIV status and HIV risk behaviors. Most studies of NMPD have either recruited samples that do not include IDUs or have not examined them as a distinct group. This lack of attention to the unique needs of IDUs may hamper the progress of clinical and public health efforts to prevent, identify, and treat NMPD, and to effectively address HIV risk behaviors and wellness among IDUs. A critical barrier to designing and implementing interventions for NMPD is that the term nonmedical use captures a heterogeneous range of motivations for use. These motivations for NMPD may be broadly categorized as euphoric (e.g., combining illicit and prescription drugs for greater effect) and self-treatment (e.g., use without a legitimate prescription to alleviate physical pain, negative mood, or drug withdrawal). Further, there may be important differences in the sources (e.g., health clinics, Emergency Department [ED], pharmacy, friends) and mechanisms (e.g., theft, sharing) used in procuring prescription medications based on underlying motivations for use. Prior work typically has combined multiple motivations into a single category of NMPD. Therefore, innovative studies, such as those targeting high volume consumers like IDUs, are needed to disaggregate NMPD into subtypes based on motivations for use. Information on NMPD motivational subtypes and associated characteristics (e.g., sequences of onset, patterns and predictors of consumption and acquisition) is an important area for future research, as those using for self-treatment may require different intervention strategies from those who use for euphoria. Using targeted sampling, we will recruit 750 IDUs in San Francisco and collect life history data at a baseline assessment and conduct a 6-month follow-up to: Aim 1: Assess the lifetime patterns of initiation and current consumption practices for IDU and NMPD, and differences in relation to HIV status and HIV risk behaviors; Aim 2: Examine the influence of biological, psychological, and social-contextual characteristics on NMPD and motivational subtypes of NMPD; Aim 3: Characterize the sources, mechanisms, and perceived access to NMPD, and examine differences by motivational subtypes of NMPD; Aim 4: Characterize how access to health care (e.g., substance abuse treatment, HIV care) influences consumption patterns and diversion practices.