Mixed methods study of polysubstance use to optimize overdose prevention

项目摘要 多药使用（PDU）越来越多地被认为是美国过量用药危机的一个关键因素， 仅去年一年就有超过十万美国人死亡药物过量仍然是很高的 与阿片类药物使用有关，但也绝大多数发生在药物组合的背景下-特别是 兴奋剂和合成阿片类药物。2019年，东北部的过量死亡比例最高 涉及合成阿片类药物的死亡人数和涉及兴奋剂的过量死亡人数的最大绝对增幅， 马里兰州的吸毒过量率是全国最高的。过量预防基础设施没有 但仍被优化以解决PDU和相关体验的异质性。具有多级 基于生命历程和社会网络理论的视角，提出了一种多阶段的混合方法 一项研究，旨在检查PDU和过量人群的模式、轨迹、风险和保护因素 兴奋剂和阿片类药物的使用模式多种多样。我们将使用艾滋病相关的行为数据， 静脉内经验（ALIVE）研究，以确定PDU模式和轨迹，混合方法数据来自 2019年全州药物使用和服务人种学评估（SEADS）项目，以确定描述性 PDU轨迹和背景下的药物使用过渡和稳定期，以及补充定性 生命历程数据收集（n=100），以探索与不同类型相关的近期变化和生命历程事件 这反过来将告知PDU类型和过量的风险和保护因素的统计模型。 这项研究的结果将允许项目规划者估计PDU之间异质性的范围和规模 并且开始理清PDU的唯一子组的干预需求。该项目将导致具体的 为减少过量用药风险量身定制的方法和支持性资源的建议 PDU的异构需求和PDU轨迹的关键转折点。我们将翻译我们的发现， 与当地利益攸关方、伙伴组织和政府合作，进行广泛传播 各机构在所有三个项目年中以真实的时间告知过量用药和治疗方案。

Project Summary Polydrug use (PDU) is increasingly implicated as a crucial factor underlying the U.S. overdose crisis, responsible for the deaths of over 100,000 Americans in the past year alone. Overdose is still highly associated with opioid use, but also overwhelmingly occurs in the context of combinations of drugs - notably stimulants and synthetic opioids. In 2019, the Northeast had the highest proportion of overdose deaths involving synthetic opioids and the largest absolute increase in stimulant-involved overdose deaths, and the Maryland overdose rate was among the highest in the country. The overdose prevention infrastructure has not yet been optimized to address PDU and the heterogeneity of associated experiences. With a multi-level perspective informed by life course and social network theories, we propose a multi-phase mixed methods study to examine patterns, trajectories, and risk and protective factors for PDU and overdose among people with various patterns of stimulant and opioid use. We will use behavioral data from the AIDS Linked to the IntraVenous Experience (ALIVE) study to identify PDU patterns and trajectories, mixed methods data from the 2019 Statewide Ethnographic Assessment of Drug Use and Services (SEADS) project to identify descriptive PDU trajectories and contextualize periods of drug use transition and stability, and complementary qualitative life course data collection (n=100) to explore recent changes and life course events aligned with different types of PDU, which will in turn inform statistical models of risk and protective factors for PDU types and overdose. Results from this study will allow program planners to estimate range and scale of heterogeneity among PDU and begin to disentangle intervention needs of unique sub-groups of PDU. This project will result in specific recommendations for tailored overdose risk reduction approaches and supportive resources for the heterogeneous needs of PDU and key turning points of PDU trajectories. We will translate our findings and conduct broad dissemination, working with local stakeholders, partner organizations, and governmental agencies to inform overdose and treatment programs in real time and across all three project years.