Integrated Safety Optimization Services for People Who Use Drugs In Targeted Areas Of High Overdose Rates

New York University School Of Medicine, New York NY

Investigators

Linked publications, trials & patents

Abstract

Over 100,000 people died from drug overdoses in the United States in 2023, a 3% decrease from 2022. Although rates declined slightly nationwide, some geographic areas, known as “hotspots” continue to experience high overdose rates and a far higher burden of drug-related harm. New York City and New Haven have had some of the highest and rising overdose rates for years. While effective treatment exists for people who use drugs (PWUD) along with safety optimization services that decrease substance-related harms, studies demonstrate that PWUD in these hotspots 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 safety optimization services for drug use or be retained in evidence-based treatment such as medication for addiction treatment (MAT). To tackle these unique problems, we created an integrated safety optimization intervention which is mobile and flexible to the needs of PWUD in hotspots. This intervention employs a community health representative to assess vulnerabilities in eight areas: emotional, physical, spiritual, social, intellectual, occupational, environmental, and financial, and then link people to services. Data from community partners who operate safety optimization services for drug use and largely serve hotspots, suggest that participants who receive these services have significant improvements in health outcomes. Yet, systemic barriers to social services NOT directly related to substance use persist, thereby limiting the positive influences on health outcomes and overall quality of life. Thus, offering a low barrier, geographically distributed intervention to targeted communities may prove a highly disseminable strategy for improving access to services and MAT. We plan to evaluate the efficacy of this intervention on participant retention and engagement of safety optimization services among PWUD (n=200) in areas with high overdose rates compared to services as usual in two mobile safety optimization organizations. The escalating overdose death rates are a serious public health crisis of high significance to both the National Institute on Drug Abuse (NIDA) and the broader public health community. The intervention could serve as an effective model to tackle this crisis as it will reduce mortality and morbidity related to substance misuse in hotspots. The intervention is specifically designed to target hotspots and offers a mobile and adaptable solution to reduce overdoses, where they are most prevalent and can be scaled to meet the needs of high-risk communities. It also improves access to evidence-based treatment and removes barriers in connection to other services. This study will provide a better understanding of the standard of care currently available in hotspots, helping to refine and enhance overdose prevention strategies where they are most needed.