R01DA057673

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

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.

The Johns Hopkins University

TO SUPPORT BASIC AND CLINICAL NEUROSCIENCE, BIOMEDICAL, BEHAVIORAL AND SOCIAL SCIENCE, EPIDEMIOLOGIC, HEALTH SERVICES AND HEALTH DISPARITY RESEARCH. TO DEVELOP NEW KNOWLEDGE AND APPROACHES RELATED TO THE PREVENTION, DIAGNOSIS, TREATMENT, ETIOLOGY, AND CONSEQUENCES OF DRUG ABUSE AND ADDICTION, INCLUDING HIV/AIDS. TO SUPPORT RESEARCH TRAINING AND RESEARCH SCIENTIST DEVELOPMENT. TO SUPPORT DISSEMINATION OF RESEARCH FINDINGS. SMALL BUSINESS INNOVATION RESEARCH (SBIR) LEGISLATION IS INTENDED TO EXPAND AND IMPROVE THE SBIR PROGRAMS TO EMPHASIZE AND INCREASE PRIVATE SECTOR COMMERCIALIZATION OF TECHNOLOGY DEVELOPED THROUGH FEDERAL SBIR RESEARCH AND DEVELOPMENT, INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN THE SBIR PROGRAM. THE LEGISLATION INTENDS THAT THE SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.279 - Drug Abuse and Addiction Research Programs

National Institute on Drug Abuse (NIDA) [HHS - NIH]

Baltimore, Maryland 212183637 United States

Single Zip Code

HEAL Initiative: Understanding Polysubstance Use and Improving Service Delivery to Address Polysubstance Use (R01 Clinical Trial Optional) (RFA-DA-22-047)

Amendment Since initial award the End Date has been extended from 09/29/25 to 07/31/27 and the total obligations have increased 41% from $2,158,107 to $3,051,259.