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

• 批准号: 9124571
• 负责人: Peter John Davidson
• 金额: $ 50.19万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9124571
• 关键词: 911 call; Accounting; Adopted; Adverse effects; Affect; Aftercare; Antidotes; Area; Attention; Behavior; Cessation of life; Communities; Complement; County; Crime; Data; Data Analyses; Decision Making; Decision Trees; Drug Controls; Drug Monitoring; Drug user; Emergency Situation; Emergency medical service; Epidemic; Ethnography; Evaluation Research; Event; Fatality rate; Fright; Geographic state; Goals; Health; Housing; Human Resources; Individual; Injury; Institutes; Intervention; Interview; Justice; Law Enforcement; Law Enforcement Officers; Laws; Lawyers; Life; Medical; Medical emergency; Methods; Modeling; Motor Vehicles; Naloxone; Narcotic Antagonists; Natural experiment; Nose; Opioid; Overdose; Pharmaceutical Preparations; Pharmacotherapy; Phase; Pilot Projects; Police; Policies; Positioning Attribute; Process; Protocols documentation; Public Health; Qualitative Methods; Records; Recruitment Activity; Research; Research Project Grants; Sampling; Statutes and Laws; Time; Training; United States; Withdrawal Symptom; Work; base; design; emergency service responder; empowered; improved; innovation; intervention program; novel; overdose death; peer; primary outcome; programs; public health relevance; response; rural area; theories; uptake; willingness

 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（由适用提供）：与药物相关的过量死亡现在是美国受伤死亡的最大原因，在2008年将与机动车相关的死亡黯然失色。在过去的十年中，由于这种流行病，包括处方药监测计划，在过去的十年中出现了许多干预措施；改善与药物治疗的联系；培训吸毒者和周围的人，以识别和适当地对过量服用；最近，培训和装备执法人员在过量现场使用纳洛酮（阿片类药物）。为执法人员配备纳洛酮，旨在利用这样一个事实，即官员经常在其他紧急服务（尤其是在粗糙地区）之前到达过量的现场，直到现在到现在为止，还没有能力应对过量事件。在过去的五年中，在白宫国家药物管制政策和司法部的积极鼓励下，至少28个州的执法机构正计划或已经开始携带纳洛酮在服用过量时使用。尽管这种计划的扩散，但这种干预措施是完全未研究的。 2014年，圣地亚哥警长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来对过量用药做出反应，并在复兴后积极将过量滥用滥用滥用到合作的药物治疗局。药物治疗的吸收高于预期（该项目的6个月试点阶段中的9个复兴中有3例进入治疗）。我们假设过量用药后的时刻代表了“可教的时刻”，吸毒者可能会更有动力进入治疗。此外，我们假设让执法人员作为医疗紧急情况而不是作为犯罪现场对过量用药的反应可能会使吸毒者在某人过量时更愿意致电911。这项研究的总体目的是确定执法使用纳洛酮对药物过量的反应对两个主要结果的反应：（1）对执法人员提到的过量滥用药物的滥用，（2）（2）呼吁911召集911的药物使用者召唤药物使用者，这些药物使用药物使用者见证了过量。我们将通过一项混合方法研究来实现这些目标，其中包括通过与SDSD，其药物治疗伙伴McAlister Institute和San Diego县的合作伙伴关系的辅助分析，包括911个调度数据，SDSD病例记录和治疗数据。为了补充这些数据，我们将对吸毒者的社区招募样本进行定性访谈，以评估他们围绕SDSD代表提供的治疗转介的观点，以及在见证过量服药的情况下愿意致电911。访谈和分析将利用从基础理论和人种学决策树建模中得出的方法（一种严格的定性方法，用于描述个人和组织如何在给定情况下做出决策）。