Culturally Response Integrated Harm Reduction Services for Black and Latinx People Who use Drugs

这项研究是NIH帮助结束成瘾长期(Hear)倡议的一部分，该倡议旨在加快科学解决国家阿片类药物公共健康危机的速度。NIH Hear Initiative支持整个NIH的研究，以改善阿片类药物滥用和成瘾的治疗。2021年有超过10万人死于吸毒过量，这突显了采取紧急行动的必要性。虽然白人的服药过量死亡率已经开始趋于平稳，但种族/族裔小型化个人的死亡人数却急剧上升。与其他药物的使用也有明显的差异，包括使用兴奋剂的黑人和拉丁裔吸毒者(PWUD)。虽然对有问题的物质使用有有效的治疗，以及减少与物质有关的伤害的减少危害(HR)服务，但研究表明，种族/族裔少数化的人不太可能获得这些服务。他们不仅经历了与滥用药物有关的更多负面后果，而且也不太可能接受人力资源服务或被保留在MAT等循证治疗中。为了解决这些独特的问题，我们创建了一个综合减少伤害干预(IHRI)，以灵活地满足黑人和Latinx PWUD的需求。这个响应文化的IHRI将雇用一名人力资源护理协调员，负责评估健康的社会决定因素(SDOH)中的脆弱性，并将人们与所需的服务联系起来。数据来自 运营人力资源服务并主要服务于黑人和拉丁裔PWUD的社区合作伙伴表明，接受人力资源服务的参与者在健康和参与度方面有显著改善。然而，与物质使用没有直接关系的额外社会服务的系统性障碍依然存在，这往往会影响健康结果和生活质量。因此，提供低门槛、地理分布、文化知识丰富的人力资源 对历史上被排斥的社区的干预可能被证明是一种高度可传播的战略，以改善获得人力资源服务和MAT的机会。我们计划评估这种综合人力资源干预措施(通过提供法律、住房和心理健康治疗支持，以及与MAT的联系)在n=200名黑人和拉丁裔PWUD中保留和参与人力资源服务方面的效果，并与两个流动社区减少伤害组织中的常规服务进行比较。黑人和拉丁裔PWUD中不断攀升的过量死亡率是一个严重的公共健康问题。对成瘾健康差异的关注对NIDA来说是高度优先的，并可能被证明是减少伤害和扩大黑人和拉丁裔PWUD患者获得垫子的有用模式，他们有 在传统环境中，这些服务历来被排除在外。

This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction. Over 100,000 people died from drug overdoses in 2021, underscoring the need for urgent action. While the rates of overdose deaths among White people have begun to plateau, there has been a drastic surge in deaths among racial/ethnic minoritized individuals. There are also stark disparities from other substance use, including stimulants among Black and Latinx people who use drugs (PWUD). While effective treatment exists for problematic substance use, along with harm reduction (HR) services that decrease substance-related harms, studies demonstrate that racial/ethnic minoritized people are less likely to have access to these services. They not only experience more negative consequences related to substance misuse but are also less likely to receive HR services or be retained in evidence-based treatment such as MAT. To tackle these unique problems, we created an integrated harm reduction intervention (IHRI) to be mobile and flexible to the needs of Black and Latinx PWUD. This culturally responsive IHRI will employ a HR care coordinator that can assess vulnerabilities in the social determinants of health (SDOH) and link people to needed services. Data from community partners who operate HR services and serve largely Black and Latinx PWUD suggests that participants who receive HR services have significant improvements in health and engagement. Yet, systemic barriers to additional social services NOT directly related to substance use persist, which often influence health outcomes and quality of life. Thus, offering a low barrier, geographically distributed, culturally informed HR intervention in historically excluded communities may prove a highly disseminable strategy, for improving access to HR services and MAT. We plan to evaluate the efficacy of this integrated HR intervention (by providing legal, housing and mental health treatment support, along with linkage to MAT) on participant retention and engagement of HR services among n=200 Black and Latinx PWUD compared to services as usual in two mobile Community Harm Reduction Organizations. The escalating overdose death rates among Black and Latinx PWUD is a serious public health. The focus on health disparities in addiction is of high priority to NIDA and may prove a useful model for decreasing harm and broadening MAT access for Black and Latinx PWUD, who have been historically excluded these services in traditional settings.