Document text
Principal Investigator: Thomas Kerr
Organization: UNIVERSITY OF BRITISH COLUMBIA
Fiscal Year: 2024
Award: $564,980
Funding agency: National Institute on Drug Abuse
PROJECT SUMMARY/ABSTRACT
Overdoses deaths have increased sharply in Canada and the US since the outset of the COVID-19 pandemic.
While fentanyl is a critical driver of North America’s overdose epidemic, rising fentanyl-stimulant polysubstance
use and ongoing drug supply changes (fluctuating fentanyl potency, adulteration of fentanyl with novel
psychoactive substances) are worsening the situation and pose challenges to overdose prevention and addiction
treatment approaches. There has been a lack of research into these emerging dynamics and how they intersect
with social, structural, and environmental influences to shape overdose vulnerability and the effectiveness of the
overdose response. Based in Vancouver, Canada, this study will employ an innovative ethno-epidemiological
approach to address this critical research gap by: (1) characterizing how evolving drug use patterns and supply
changes impact overdose vulnerability; (2) examining how changing drug use patterns and drug supply changes
intersect with social, structural, and environmental influences to impact the effectiveness of overdose prevention
interventions; and (3) exploring social, structural, and environmental influences on treatment outcomes for
existing and emerging opioid agonist treatment (OAT) approaches among fentanyl-stimulant polysubstance-
using and NPS exposed PWUD. Vancouver is the ideal setting to undertake the proposed research. Vancouver
had implemented innovative overdose prevention and addiction treatment interventions that led to significant
decreases in overdose deaths and that were later implemented – or are now being considered – elsewhere in
the US and internationally, including drug checking programs, supervised consumption sites, and low-threshold
oral and injectable OAT. This comprehensive overdose response is being adapted in response to rising overdose
deaths attributed to fentanyl-stimulant polysubstance use and drug supply changes, including by expanding
drug-checking approaches (benzodiazepine testing strips), expanding OAT options (e.g., oral and injectable
OAT), implementing supervised inhalation services, and integrating OAT a contingency management and
detoxification services. This study will be nested within the research infrastructure of the BC Centre on Substance
Use, which includes three NIDA-funded, longitudinal cohort studies of PWUD and a NIDA-funded drug-checking
program evaluation. This approach will enable epidemiologically-informed sampling and targeted recruitment of
PWUD and facilitate the integration of qualitative data and cohort-based and drug surveillance data. Extending
our ethno-epidemiological research to examine how a comprehensive response to the overdose epidemic is
being adapted to rising fentanyl-stimulant polysubstance use and drug supply changes will result in a more
nuanced and complete understanding of influences on the effectiveness of the overdose response than is
possible through epidemiological research alone. The proposed research is aligned with NIH and NIDA strategic
priorities and will generate evidence critical to optimizing the response to the overdose epidemic.
Terms: <Actiq><Address><Behavioral><Benzodiazepine Compounds><Benzodiazepines><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Canada><Characteristics><Clinical><Cohort Studies><Collaborations><Complex><Concurrent Studies><Consumption><Data><Diacetylmorphine><Diamorphine><Drug Adulterations><Drug Metabolic Detoxication><Drug Metabolic Detoxification><Drug usage><Drug user><Drugs><Duragesic><Effectiveness><Environment><Epidemic><Epidemiologic Research><Epidemiologic Studies><Epidemiological Studies><Epidemiology><Epidemiology Research><Ethnography><Evaluation><Fentanest><Fentanyl><Fentyl><Fostering><Funding><Harm Minimization><Harm Reduction><Health system><Heroin><Housing><Impoverished><Individual><Inequity><Inhalation><Inhaling><Injectable><Interdisciplinary Research><Interdisciplinary Study><International><Intervention><Intervention Strategies><Interview><Long-term cohort study><Longitudinal cohort study><Longterm cohort study><Medication><Metabolic Drug Detoxications><Metabolism of Toxic Agents><Multidisciplinary Collaboration><Multidisciplinary Research><NIDA><NIH><Naloxone Training><National Institute of Drug Abuse><National Institute on Drug Abuse><National Institutes of Health><North America><Opiates><Opioid><Oral><Outcome><Overdose><PWUD><Pattern><Pharmaceutical Preparations><Phentanyl><Population><Poverty><Prevalence><Preventative intervention><Program Evaluation><Public Health><Qualitative Methods><Research><Research Infrastructure><Risk><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Sampling><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Shapes><Site><Social Sciences><Stimulant><Treatment outcome><United States National Institutes of Health><addiction><addictive disorder><cohort><community partnership><contingency management><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><detoxification><disparity in health><distribute naloxone><drug use><drug/agent><effectiveness/implementation hybrid study><effectiveness/implementation study><epidemiologic><epidemiologic investigation><epidemiological><epidemiology study><ethnographic><evidence base><experience><fentanyl test><fentanyl use><health disparity><health disparity community><health disparity group><health disparity populations><improved><innovate><innovation><innovative><insight><interest><intervention for prevention><interventional strategy><licit opioid><multiple data sources><multiple substance use><multisubstance use><naloxone availability><naloxone dispensary><naloxone dispensation><naloxone dispensing><naloxone distribution><naloxone provision><novel><opiate medication><opioid agonist therapy><opioid agonist treatment><opioid medication><overdose death><overdose fatalities><overdose prevention><people who use drugs><people who use illicit drugs><persons who use drugs><point of care><poly substance use><polysubstance use><prescribed opiate><prescribed opioid><prescription opiate><prescription opioid><prevention intervention><preventional intervention strategy><preventive intervention><programs><provide naloxone><qualitative reasoning><recruit><response><response to therapy><response to treatment><scale up><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><social structural><social structure><socio-structural><sociostructural><substance use><substance using><surveillance data><test for fentanyl><test strip><therapeutic response><therapy response><treatment program><treatment response><treatment responsiveness>