Risk and Benefits of Overdose Education and Naloxone Prescribing to Heroin Users

过量教育和向海洛因使用者开纳洛酮处方的风险和益处

基本信息

批准号：
9330829
负责人：
SANDRA D COMER
金额：
$ 53.42万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-15 至 2019-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9330829
关键词：
Abstinence Address Adverse event Affect Area Behavior Benefits and Risks Cessation of life Data Drug Combinations Drug Metabolic Detoxication Drug usage Education Effectiveness Effectiveness of Interventions Emergency Situation Frequencies Friends Funding Grant Harm Reduction Health Health Personnel Heroin Heroin Users Imprisonment Incentives Individual Injectable Instruction Intervention Investigation Knowledge Location Measures Medical Mental Health Methods Modification Naloxone Narcotic Antagonists Needle-Exchange Programs Neighborhoods New York City Opioid Outcome Outcome Measure Overdose Participant Patient Self-Report Pattern Persons Pharmaceutical Preparations Poisoning Population Premature Mortality Prevalence Prevention Prevention program Prospective Studies Public Health Randomized Recording of previous events Recruitment Activity Reporting Research Resuscitation Retrospective Studies Review Literature Risk Assessment Safety Sedation procedure Services Site Sodium Chloride Spouses Symptoms Techniques Time Training Training Programs Training and Education Ventilatory Depression Water experience follow-up heroin overdose high risk illicit drug use improved mortality novel novel strategies opioid abuse opioid use overdose death overdose prevention prescription opioid programs prospective psychosocial public health relevance response substance abuser treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Heroin overdose is the leading cause of premature mortality among heroin users (Smyth et al., 2007), and is the second most common drug responsible for poisoning deaths in New York City. Although deaths due to unintentional drug overdose decreased overall by 24% in NYC between 2005 and 2009, prescription opioid deaths increased by 20% during this same time period (Epi Data Brief, New York City Department of Health and Mental Hygiene (NYC DOHMH), 2011). A new harm reduction approach attempts to decrease opioid overdose by educating users in recognizing its symptoms and in using naloxone to reverse opioid-induced respiratory depression. In the proposed studies, we will attempt to obtain data on the impact that these programs may have on the health and outcomes of a population of opioid users at high risk for witnessing and experiencing an opioid overdose. We have preliminary evidence supporting the need for modifications of existing training programs to improve accurate identification of opioid overdose. Furthermore, a review of the literature has revealed that more extensive research, including proactive, long-term follow-up, is needed to better identify all of the benefits and risks associated with this approach. Specifically our investigation will recruit ongoing and recently detoxified opioid abusers from several sites throughout the NYC area. All participants will receive standard opioid overdose education training and naloxone to carry should they witness another person experiencing an overdose, or overdose themselves. One-third of the participants will be randomized to receive additional in-depth psychosocial education focusing on recognition and prevention of opioid overdose, and appropriate use of naloxone. Another one-third of the participants will receive the extensive training and be required to engage a spouse, partner, relative, or friend in this supplementary intervention. We expect that these psychosocial interventions (extensive training and training of a significant other) will improve overdose outcome measures. We also expect that the occurrence of naloxone-related adverse events will be minimal, and that access to naloxone will not significantly alter drug use patterns. The results of this study should provide one of the firs prospective and systematic assessments of the risks and benefits of this novel practice in the U.S., and educate the field on how we may improve upon current practices. In addition to conducting a prospective study, we also propose to conduct a retrospective analysis of the overall impact of overdose education and training in the use of naloxone by examining data collected by the NYC DOHMH. Specifically, both fatal and non-fatal opioid overdose rates will be compared in neighborhoods with facilities that offer overdose prevention training and naloxone to those that do not. We anticipate that the prevalence of fatal opioid overdose will be significantly lower in neighborhoods where opioid overdose prevention training and naloxone are offered.

描述（由申请人提供）：海洛因过量是海洛因使用者过早死亡的主要原因（Smyth等，2007），并且是纽约市中毒死亡中毒的第二大药物。尽管在2005年至2009年期间，纽约市纽约市因无意药过量造成的死亡人数降低了24％，但在同一时期，处方阿片类药物的死亡人数增加了20％（EPI数据摘要，纽约市卫生与精神卫生部（NYC DOHMH），2011年，2011年）。一种新的危害减少方法试图通过教育用户识别其症状并使用纳洛酮来逆转阿片类药物诱导的呼吸道抑郁，从而减少阿片类药物过量。在拟议的研究中，我们将尝试获取有关这些计划可能对目击和体验阿片类药物过量风险的阿片类药物使用者的健康和结果的影响的数据。我们有初步证据，支持对现有培训计划进行修改，以改善阿片类药物过量的准确识别。此外，对文献的回顾表明，需要更广泛的研究，包括积极的长期随访，以更好地确定与这种方法相关的所有好处和风险。具体来说，我们的调查将招募来自纽约市多个地点的正在进行的和最近排毒的阿片类药物滥用者。所有参与者将接受标准的阿片类药物过量教育培训和纳洛酮，如果他们亲眼目睹另一个人过量或过量服用的人。三分之一的参与者将被随机分配，以接受额外的深入的社会心理教育，重点是识别和预防阿片类药物过量，并适当使用纳洛酮。另外三分之一的参与者将接受广泛的培训，并被要求与配偶，伴侣，亲戚或朋友一起参加这种补充干预。我们预计这些社会心理干预措施（对他人的广泛培训和培训）将改善过量的结果指标。我们还期望与纳洛酮相关的不良事件的发生将是最小的，并且获得纳洛酮不会显着改变药物使用模式。这项研究的结果应为美国新颖实践的风险和好处提供FIR的预期和系统评估之一，并就我们如何改善当前实践进行教育。除了进行一项前瞻性研究外，我们还建议通过检查纽约DOHMH收集的数据，对过量教育和培训在使用纳洛酮中的总体影响进行回顾性分析。具体而言，将比较致命的和非致命的阿片类药物过量率，这些设施提供了预防过量培训的设施，而纳洛酮则将与那些不提供过量的纳洛酮进行比较。我们预计，在提供阿片类药物预防训练和纳洛酮的社区中，致命阿片类药物过量的患病率将大大降低。