Impacts of a Novel law-enforcement delivered intervention on drug user health

新型执法干预措施对吸毒者健康的影响

基本信息

批准号：
9438407
负责人：
Peter John Davidson
金额：
$ 46.51万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-05-01 至 2022-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9438407
关键词：
911 call Adopted Affect Aftercare Antidotes Area Attention Behavior Cessation of life Communities Complement County Crime Data Data Analyses Decision Making Decision Trees Drug Controls Drug user Emergency Situation Emergency medical service Epidemic Ethnography Evaluation Research Event Fatality rate Fright Goals Health Human Resources Individual Injury Institutes Intervention Interview Justice Law Enforcement Law Enforcement Officers Lawyers Life Medical Medical emergency Methods Modeling Motor Vehicles Naloxone Natural experiment Nose Opioid Opioid Antagonist Organizational Decision Making Overdose Pharmaceutical Preparations Pharmacotherapy Phase Pilot Projects Police Policies Positioning Attribute Process Protocols documentation Public Health Qualitative Methods Records Research Research Project Grants Sampling Savings Statutes and Laws Time Training United States Withdrawal Symptom base design empowered first responder health goals improved innovation novel opioid mortality opioid overdose overdose death peer prescription monitoring program primary outcome programs public health relevance recruit response rural area secondary analysis side effect theories uptake willingness

项目摘要

DESCRIPTION (provided by applicant): Drug-related overdose deaths are now the largest cause of injury death in the United States, having eclipsed motor vehicle-related deaths in 2008. A number of interventions have emerged in the last decade in response to this epidemic, including prescription drug monitoring programs; improving linkages to drug treatment; training drug users and those around them to recognize and respond appropriately to overdose; and, most recently, training and equipping law enforcement officers to use naloxone (an opioid antagonist) at the scene of an overdose. Equipping law enforcement officers with naloxone is intended to capitalize on the fact that officers often arrive at an overdose scene before other emergency services, particularly in rural areas, and until now have not been well equipped to deal with overdose events. In the last 5 years, with the active encouragement of the White House Office of National Drug Control Policy and the Department of Justice, law enforcement agencies in at least 28 states are planning to or have begun carrying naloxone to use when they attend overdoses. Despite the proliferation of such programs, this intervention is completely unstudied. In 2014 the San Diego Sheriff's Department began training patrol officers to use naloxone to respond to overdose prior to arrival of other emergency services, and to actively refer overdose victims to a collaborating drug treatment agency after revival. Uptake of drug treatment has been higher than expected (3 of 9 revivals in the 6 month pilot phase of the project entered treatment). We hypothesize that the moments after an overdose represent a "teachable moment" in which drug users may be more motivated to enter treatment. In addition, we hypothesize that having law enforcement officers respond to overdose as a medical emergency rather than as a crime scene may make drug users more willing to call 911 when someone overdoses. The overarching goal of this study is to determine the impact of law enforcement use of naloxone to respond to drug overdoses on two primary outcomes: (1) uptake of drug treatment referrals by overdose victims referred by law enforcement officers, and (2) rates of calling 911 to summon emergency medical services by drug users who witness overdoses. We will achieve these aims through a mixed methods study that includes secondary analysis of data available through our partnership with SDSD, their drug treatment partners the McAlister Institute, and the County of San Diego, including 911 dispatch data, SDSD case records, and treatment data. To complement these data we will conduct qualitative interviews with a community-recruited sample of drug users, to assess their perspectives around treatment referrals provided by SDSD Deputies, and their willingness to call 911 in the event of witnessed overdoses. Interviews and analysis will utilize methods drawn from grounded theory and ethnographic decision tree modeling (a rigorous qualitative method used to describe how individuals and organizations make decisions in given situations).

描述（由申请人提供）：与药物相关的过量死亡现在是美国伤害死亡的最大原因，超过了 2008 年与机动车相关的死亡。过去十年中出现了许多干预措施来应对这一流行病，包括处方药监测计划；改善与吸毒者及其周围人的联系，以识别和适当应对过量用药；最近，培训和装备执法人员使用纳洛酮（一种阿片类拮抗剂）；为执法人员配备纳洛酮的目的是利用以下事实：警察经常先于其他紧急服务部门到达用药过量现场，特别是在农村地区，而且迄今为止还没有足够的装备来处理用药过量事件。过去5年来，在白宫国家毒品管制政策办公室和司法部的积极鼓励下，至少有28个州的执法机构正在计划或已经开始携带纳洛酮，以在服药过量时使用。此类的扩散2014 年，圣地亚哥治安部门开始培训巡逻人员在其他紧急服务到达之前使用纳洛酮应对服药过量，并在康复后积极将服药过量的受害者转介给合作的药物治疗机构。药物治疗的比例高于预期（项目治疗进入 6 个月试点阶段后，9 例复苏中的 3 例），我们发现，服药过量后的时刻代表了吸毒者可能更有动力的“受教育时刻”。此外，我们还认为，让执法人员将吸毒过量视为医疗紧急情况而不是犯罪现场，可能会让吸毒者在有人吸毒过量时更愿意拨打 911。执法部门使用纳洛酮应对吸毒过量对两个主要结果的影响：(1) 执法人员转介的吸毒过量受害者接受戒毒治疗转介的情况；(2) 吸毒者拨打 911 寻求紧急医疗服务的比率谁见证我们将通过混合方法研究来实现这些目标，其中包括对我们与 SDSD、其药物治疗合作伙伴麦卡利斯特研究所和圣地亚哥县合作获得的数据进行二次分析，包括 911 调度数据、SDSD 病例记录和为了补充这些数据，我们将对社区招募的吸毒者样本进行定性访谈，以评估他们对 SDSD 代表提供的治疗转介的看法，以及他们在无家可归者吸毒过量时拨打 911 的意愿。分析将利用扎根理论和人种学决策树模型（一种严格的定性方法，用于描述个人和组织在给定情况下如何做出决策）中得出的方法。