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Polysubstance use, overdose, and treatment discontinuation among people who use drugs in the fentanyl era

Award Number: R36DA064916
ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/15/2026
PERIOD OF PERFORMANCE END DATE: 07/31/2028

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Polysubstance use, overdose, and treatment discontinuation among people who use drugs in the fentanyl era - PROJECT SUMMARY/ABSTRACT The proposed R36 dissertation research project will identify latent polysubstance use (PSU) patterns and their longitudinal and spatial associations with methadone maintenance treatment (MMT) receipt and discontinuation in New York State to inform service delivery for people who use drugs (PWUD). The fourth wave of the overdose crisis in the United States (US) is characterized by a rise in PSU. Approximately two- thirds of opioid-related deaths now involve the use of other substances, including benzodiazepines and psychostimulants such as cocaine and methamphetamine. This growing complexity of PSU poses significant challenges for the treatment of substance use disorders. PSU has been linked to increased risks of adverse outcomes, including fatal and non-fatal overdose and reduced retention in evidence-based treatment for opioid use disorders, such as MMT. However, there is limited research on distinct patterns of PSU and their association with adverse outcomes, such as non-fatal overdoses and MMT discontinuation among PWUD, especially following the introduction of fentanyl into the drug supply. Notably, although PSU among people who inject drugs (PWID) is widespread, there remains limited understanding of PSU patterns among this high-risk population. Existing studies often rely on self-reported data and fail to include novel and emerging substances like fentanyl, xylazine, and nitazenes in PSU assessments. As overdose deaths involving PSU remain high across the US, there is an urgent need for research to better characterize PSU and inform effective prevention and treatment strategies. Using a mixed-methods approach guided by the Social Ecological Model, the proposed dissertation will address this gap through the following specific aims: Aim 1: identify latent PSU patterns using urine toxicology and self-reported data among PWID, and evaluate their association with non- fatal overdose and MMT receipt; Aim 2: examine longitudinal PSU patterns and their associations with MMT discontinuation using the New York State Office of Addiction Services and Supports (OASAS) data; Aim 3: investigate geographic variation in PSU patterns and MMT discontinuation across New York State using spatial analysis. The study will leverage data from the ongoing Risk Factors cohort study (R01DA003574; n = 600), employing latent class analysis to identify high-risk PSU classes and their associations with MMT receipt in a community-recruited sample of PWID. We will then conduct a population-based retrospective observational study using OASAS data (n ≈ 43,000) for Aims 2 and 3 to examine how longitudinal PSU patterns relate to MMT discontinuation and identify geographic and sociodemographic correlates of these patterns and outcomes among PWUD. Our proposed study will provide insights into PSU trajectories and their impact on overdose and MMT discontinuation, informing targeted interventions and enhancing the delivery of evidence- based treatment strategies in the evolving fentanyl era.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $103,607 )
2026	2026	NEW YORK UNIVERSITY	70 WASHINGTON SQ S FL 11	NEW YORK	NY	10012	NEW YORK	USA	Drug Use and Addiction Research Programs	000	1	8/5/2026	NEW	$103,607
														Subtotal = $103,607

Grand Total All Awards = $103,607

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Polysubstance use, overdose, and treatment discontinuation among people who use drugs in the fentanyl era

Award Number: R36DA064916

ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/15/2026

PERIOD OF PERFORMANCE END DATE: 07/31/2028

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