Risk and Protective factors of Polydrug Overdose in North Carolina

摘要 从2020年4月美国COVID-19大流行开始到2021年4月， 美国有10万人死于药物过量。据估计，药物过量流行病目前花费了 美国每年约1万亿美元。在过去的5-7年里，涉及多种药物（多药）的药物过量， 增长尤其迅速。目前，美国超过60%的药物过量死亡涉及多种药物， 特别是与处方阿片类药物、可卡因、苯二氮卓类药物和兴奋剂混合的非法芬太尼。在北 卡罗莱纳（NC）是这项研究的重点，超过70%的过量死亡涉及 多种药物过量，包括53%涉及至少一种阿片类药物，19%涉及多种非阿片类药物。 阿片类药物多种药物过量在美国少数种族/族裔中也不成比例地增加。 医疗保健、保险和矫正等系统，有可能实施大规模预防 缺乏相关数据来确定其人口中多种药物过量发生率的基准， 确定风险和保护因素。许多死于多种药物过量的人最近接触过 医疗保险或矫正系统。事实上，药物过量死亡率从个人医疗补助 从教养机构释放出来的人比一般人高得多。此外， 用于急性、术后或慢性疼痛的处方阿片类药物不会导致多种药物使用和过量， 明白重要的是要了解多种药物使用的途径和物质使用障碍 通过吸毒者和治疗提供者的亲身经历的透镜进行治疗。 因此，在这项混合方法研究中，我们将在四个大型研究中定义多种药物过量率和趋势。 代表公共和私人保险的个人、卫生系统患者和出院者的人群 从监禁超过16年的时间;确定人口统计学，临床和短期和长期护理的访问 预测四个人群中致命性多种药物过量风险的模式和因素;确定 在急性，术后， 和慢性疼痛与致命性多种药物过量的风险增加有关;并阐明 途径多种药物使用和过量的人与生活的经验，并了解障碍，以有效的 物质使用障碍治疗以及与提供者提供的这种治疗的联系和减少危害 专业人士我们还将研究预测模型中的种族差异和种族算法偏见， 开发可帮助临床医生和惩教人员识别多种药物高风险人群的工具 过量死亡，并将其与适当的治疗方案联系起来。这项工作将利用数据资源 和联系，从而最大限度地利用资源， 提高我们通过卫生系统、保险提供者、 以及北卡罗来纳州和美国的监狱。

ABSTRACT From April 2020, the start of the COVID-19 pandemic in the US, to April 2021, there were more than 100,000 drug overdose deaths in the US. It is estimated that the drug overdose epidemic currently costs the US about $1 trillion each year. Over the past 5-7 years, drug overdoses involving multiple drugs (polydrug) has increased especially rapidly. More than 60% of all drug overdose deaths in the US now involve multiple drugs, especially illicit fentanyl mixed with prescription opioids, cocaine, benzodiazepines, and stimulants. In North Carolina (NC), the state where the proposed study focuses, more than 70% of overdose deaths involve polydrug overdoses, including 53% which involve at least one opioid and 19% which involve multiple non- opioids. Polydrug overdoses are also increasing disproportionately among racial/ethnic minority Americans. Systems like healthcare, insurers, and corrections, which have the potential to implement large prevention initiatives, lack the linked data to establish benchmarks of polydrug overdose incidence in their populations and define risk and protective factors. Many people who die from polydrug overdose have had recent contact with healthcare, insurance, or correctional systems. In fact, drug overdose death rates from individuals on Medicaid and those released from correctional settings are much higher than the general population. Further, the role of prescription opioids for acute, post-surgical, or chronic pain in leading to polydrug use and overdose is not understood. It is important to understand pathways to polydrug use and barriers to substance use disorder treatment through the lens of lived experience of persons who use drugs and treatment providers. Therefore, in this mixed-methods study, we will define polydrug overdose rates and trends in four large populations representing publicly and privately insured individuals, health system patients, and those released from incarceration over a 16-year period; identify demographic, clinical, and short- and long-term care access patterns and factors that predict risk of fatal polydrug overdoses in each of the four populations; identify prescription opioid pain management trajectories in longitudinal cohorts of patients with acute, post-surgical, and chronic pain that are associated with increased risk of fatal polydrug overdoses; and elucidate the pathways to polydrug use and overdose people with lived experience and understand barriers to effective substance use disorder treatment and linkage to such treatment from providers and harm reduction professionals. We will also examine racial disparities and racial algorithmic bias in prediction models and develop tools that may aid clinicians and corrections officers to identify people at high risk for polydrug overdose deaths and connect them with appropriate treatment options. This work will leverage data resources and linkages developed from our prior and ongoing studies, thereby maximizing resources, and greatly advancing our ability to develop evidence-based interventions through health systems, insurance providers, and corrections in North Carolina and the United States.