The short and long-term dynamics of opioid/stimulant use: Mixed methods to informoverdose prevention and treatment related to polysubstance use

项目摘要。2020年，美国服药过量死亡人数超过10万人。而阿片类药物与 在很大程度上可归因于芬太尼的死亡人数继续上升，包括可卡因在内的与兴奋剂有关的死亡人数 自2013年以来增长了300%以上。美国持续的吸毒危机的一个日益增长的驱动因素是 同时使用多种物质。尽管有药物治疗来解决阿片类药物的使用问题 混乱，几乎没有基于证据的选择来解决人们同时使用兴奋剂的问题 使用阿片类药物。了解多物质使用的动态，特别是阿片类药物和兴奋剂的共同使用；以及 在共同使用的动态方面，治疗的作用对于为正在进行的过量用药预防提供信息至关重要。 然而，关于阿片类药物和兴奋剂协同作用的模式和轨迹，我们的知识存在重大差距。 使用及其在过量用药中的作用。迫切需要描述多物质的纵向性质 社区样本的使用、治疗利用和过量用药。这样做的首要目标是 建议的目的是加深我们对阿片类药物/兴奋剂长期和短期使用模式的理解，以及 审查阿片类药物/兴奋剂联合使用与药物使用治疗之间的纵向关系 随着时间的推移，非致命和致命的服药过量，以便为治疗和预防服药过量服务提供信息。我们 提出以下三个具体目标：1)描述阿片类药物和兴奋剂共同使用的长期模式 并检查共同使用、药物使用治疗、过量用药和死亡率之间的关系； 2)审查阿片类药物和兴奋剂联合使用的实时短期模式和过渡及其 与药物使用治疗和过量用药有关；以及3)评估 扩大和加强不同类型人群的治疗和服药过量服务能力 阿片类药物/兴奋剂的使用模式。为了实现这些目标，我们将利用30多年的行为、 超过5,000名在艾滋病内注射毒品的人的实验室和临床数据与 静脉注射经验(活的)队列研究长期趋势和并发的社会决定因素 阿片类药物/兴奋剂的使用。辅以新招募的兴奋剂类阿片类药物非注射队列 (SONIC)，我们将在这两个样本中进行新的生态瞬时评估，以检查微模式 并使用最先进的机器学习方法来识别模式及其与 在这个以社区为基础的样本中，随着时间的推移，治疗和过量用药的风险很高。定性的 与利益攸关方和阿片类药物/兴奋剂共同使用模式不同的人进行的研究将突出差距和 服务系统内的挑战，并确定具体的实施战略，以提高能力 解决不同种类的阿片类药物/兴奋剂的同时使用和相关需求。这项研究的结果将 提供证据，为干预措施和政策提供信息，以改善使用多个 目的是在合成阿片类药物方面减少美国的过量死亡。

Project Summary. Overdose deaths surpassed 100,000 in the United States in 2020. While opioid-related deaths largely attributable to fentanyl continue to rise, deaths involving stimulants, including cocaine, have increased by over 300% since 2013. A growing driver of the continued overdose crisis in the US is the role of concurrent use of multiple substances. Although there are pharmacological treatments to address opioid use disorder, few evidence-based options are available for addressing concurrent stimulant use among people using opioids. Understanding the dynamics of polysubstance use, particularly opioid and stimulant co-use, and the role of treatment with respect to the dynamics of co-use, is critical to inform ongoing overdose prevention. Yet, there are major gaps in our knowledge regarding the patterns and trajectories of opioid and stimulant co- use and their role in overdose. There is an urgent need to characterize the longitudinal nature of polysubstance use, treatment utilization, and overdose in community-based samples. The overarching objective of this proposal is to further our understanding of both long- and short-term patterns of opioid/stimulant use and examine the longitudinal relationship between co-use of opioids/stimulants and substance use treatment and non-fatal and fatal overdose over time, in order to inform treatment and overdose prevention services. We propose the following three specific aims: 1) To characterize long-term patterns of opioid and stimulant co-use and examine the relationship between trajectories of co-use, substance use treatment, overdose and mortality; 2) To examine real-time short-term patterns and transitions in and out of opioid and stimulant co-use and their association with substance use treatment and overdose; and 3) To assess opportunities and readiness for expanding and strengthening service capacity related to treatment and overdose among those with different patterns of opioid/stimulant use. To achieve these aims, we will leverage over 30 years of behavioral, laboratory and clinical data from among over 5,000 people who inject drugs within the AIDS Linked to the IntraVenous Experience (ALIVE) cohort to examine long-term trends and the social determinants of concurrent opioid/stimulant use. Supplemented with new recruitment of the Stimulant Opioid Non-Injection Cohort (SONIC), we will conduct new ecological momentary assessments in both samples to examine micro-patterns of use and employ state-of-the-art machine learning methods to identify patterns and their association with treatment and overdose over time in this community-based sample at high risk of overdose. Qualitative research with stakeholders and people with differing patterns of opioid/stimulant co-use will highlight gaps and challenges within the service system and identify specific implementation strategies to increase capacity to address heterogeneous concurrent opioid/stimulant use and related needs. The results of this study will provide evidence to inform intervention and policy to improve outcomes for people who use multiple substances with the goal of reducing overdose deaths in the US in the context of synthetic opioids.