Overdose Risk Management and Compensation in the Era of Naloxone

纳洛酮时代的过量风险管理和补偿

基本信息

批准号：
10408121
负责人：
Alexander S Bennett
金额：
$ 81.5万
依托单位：
NEW YORK UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-06-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10408121
关键词：
Address Adult Age Area Attitude Awareness Behavior Behavior Therapy Behavioral Cessation of life Cities Cost Savings Data Collection Development Diagnosis Drug usage Education and Outreach Educational Curriculum Emergency Medical Technicians Emergency Situation Enrollment Ensure Ethics Ethnic Origin Ethnography Event Exposure to Failure Female Financial compensation Foundations Funding Future Geographic state Health Health Benefit Heart Heroin Human Resources Individual Injecting drug user Intention Intervention Investigation Knowledge Learning Life Measurable Mental Health Methods Naloxone Naloxone Training National Institute of Drug Abuse Neighborhoods New York City Opiate Addiction Opioid Opioid abuser Overdose Overdose reversal Participant Patient Self-Report Pattern Perception Persons Pharmaceutical Preparations Pharmacologic Substance Pharmacy facility Play Police Prevention education Prevention program Process Psychosocial Factor Public Domains Public Health Published Comment Recording of previous events Reporting Research Respondent Risk Risk Behaviors Risk Management Risk Reduction Risk-Taking Role Sampling San Francisco Severities Statutes and Laws Subgroup Surveys Testing Text Messaging Time Training Training Programs Treatment/Psychosocial Effects United States Ursidae Family base career catalyst cost design experience first responder heroin use high risk behavior illicit opioid implementation study insight interest intervention delivery male military veteran news opioid epidemic opioid overdose opioid use opioid use disorder opioid user outreach overdose education overdose prevention overdose risk prescription opioid psychosocial public health relevance recruit response safety net social social culture social structure substance use success tool uptake willingness

项目摘要

ABSTRACT As alarming rates of opioid-related overdose have come to dominate the national dialogue on drug-related harms, the overdose reversal medication naloxone has expanded from the confines of emergency medical personnel to the public domain. The rapid legislative response of many US states to the current epidemic of opioid dependence and overdose has resulted in widespread initiatives to provide naloxone not only to professional first-responders, but also to active opioid users. These initiatives have already demonstrated their worth and are responsible for thousands of overdose reversals and lives saved. To date, however, two important topic areas that bear on the ongoing success of overdose education and naloxone distribution efforts remain unexplored. The first concerns potential gaps in knowledge about and access to naloxone among people who use opioids but are not connected to opioid overdose prevention programs where the bulk of outreach is conducted. The second concerns the largely unexplored behavioral and psychosocial effects of surviving or “reversing” an overdose in which naloxone was administered and of simply having naloxone present while engaging in overdose risk behaviors. Preliminary evidence suggests that these impacts may involve different trajectories depending on individual and social-structural factors. For some, reversing an overdose has been reported to empower individuals to maintain safe opioid use practices. For others, naloxone provision has been met with a self-reported intention to use more opioids. Why naloxone provokes such widely varying responses, and for whom it produces the most robust health benefits, remain critically unexamined questions. To address these public health concerns, this study responds to the current NIDA and FDA mandate for “additional formative and implementation studies of naloxone distribution and overdose intervention in field settings, particularly for prescription opioid abusers.” Using a mixed-method approach designed to yield richly contextualized findings, the proposed study will recruit a sample of 600 people who use illicit opioids in New York City to: a) learn which subgroups of illicit opioid users have been trained in naloxone, used it, or had it used on them, and why some continue to refuse training; b) identify the risk-behavior impacts of using naloxone, surviving an overdose because of naloxone, or having naloxone and a trained overdose responder present when using illicit opioids; and, c) illuminate opioid users’ own perspectives on overdose risk management and naloxone’s role within that, and identify social-structural and psychosocial factors underlying both positive and negative changes in overdose risk behavior. Taken together, these objectives have the power to inform the tailoring and targeting of existing outreach and education strategies and to guide the development of new intervention tools for opioid users whose exposure to naloxone and overdose events may represent powerful turning- points in their drug use careers and catalysts for positive behavioral change.

抽象的随着与阿片类药物相关的过量用药的惊人发生率已成为有关毒品相关的全国对话的主导危害，过量逆转药物纳洛酮已超出紧急医疗的范围美国许多州对当前疫情的快速立法反应。阿片类药物依赖和过量导致广泛采取行动，不仅向患者提供纳洛酮专业的急救人员，也包括活跃的阿片类药物使用者，这些举措已经得到了证明。然而，迄今为止，他们的价值并导致了数千例药物过量逆转并挽救了生命。与过量用药教育和纳洛酮分发的持续成功有关的重要主题领域这些努力首先涉及纳洛酮知识和获取方面的潜在差距。在使用阿片类药物但未参与阿片类药物过量预防计划的人群中，大部分外展工作涉及很大程度上尚未探索的行为和社会心理。幸存或“逆转”服用纳洛酮的过量用药以及简单地服用纳洛酮的效果初步证据表明，纳洛酮存在于过量的危险行为中。对于某些人来说，影响可能涉及不同的轨迹，具体取决于个人和社会结构因素。据报道，扭转过量用药可以使个人保持安全的阿片类药物使用习惯。其他人，纳洛酮的规定已经满足了自我报告的使用更多阿片类药物的意图。引起如此广泛不同的反应，并且为谁带来最强劲的健康益处，仍然是为了解决这些公共卫生问题，本研究对以下问题做出了回应。当前 NIDA 和 FDA 授权“纳洛酮的额外形成和实施研究” 在现场环境中进行分发和过量干预，特别是对于处方阿片类药物滥用者。” 混合方法旨在产生丰富的情境化发现，拟议的研究将招募对纽约市 600 名使用非法阿片类药物的人进行抽样调查，目的是： a) 了解非法阿片类药物的哪些亚组用户接受过纳洛酮培训、使用过纳洛酮或有人在他们身上使用过纳洛酮，以及为什么有些人仍然拒绝培训； b) 确定使用纳洛酮的风险行为影响，由于过量服用纳洛酮而幸存下来纳洛酮，或使用非法阿片类药物时有纳洛酮和训练有素的过量反应人员在场；以及 c) 阐明阿片类药物使用者对过量风险管理的看法以及纳洛酮在其中的作用，并确定积极和消极变化背后的社会结构和社会心理因素总而言之，这些目标有能力指导制定和制定药物过量风险行为。针对现有的外展和教育战略并指导新干预措施的制定针对阿片类药物使用者的工具，他们暴露于纳洛酮和过量事件可能代表着强大的转变他们吸毒生涯中的要点和积极行为改变的催化剂。