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：
8694865
负责人：
SANDRA D COMER
金额：
$ 54.05万
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/8694865
关键词：
Abstinence Address Adverse event Affect Area Behavior Benefits and Risks Cessation of life Data Data Analyses 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 Human Resources Illicit Drugs Imprisonment Incentives Individual 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 Relative (related person)Reporting Research Resuscitation Retrospective Studies Review Literature Risk-Benefit Assessment Safety Sedation procedure Services Site Sodium Chloride Solutions Spouses Symptoms Techniques Time Training Training Programs Training and Education Ventilatory Depression Water design experience follow-up heroin overdose high risk improved mortality novel novel strategies opioid abuse 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）：海洛因过量服用是海洛因使用者过早死亡的主要原因（Smyth 等人，2007 年），也是纽约市第二大中毒死亡的最常见药物。尽管 2005 年至 2009 年间，纽约市因意外药物过量导致的死亡总体下降了 24%，但同期处方阿片类药物死亡人数却增加了 20%（Epi 数据简报，纽约市健康和心理卫生局 (NYC DOHMH)， 2011）。一种新的减少危害方法试图通过教育使用者认识其症状并使用纳洛酮逆转阿片类药物引起的呼吸抑制来减少阿片类药物过量服用。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经历阿片类药物过量的高风险阿片类药物使用者的健康和结果产生影响的数据。我们有初步证据支持需要修改现有培训计划，以提高对阿片类药物过量的准确识别。此外，对文献的回顾表明，需要进行更广泛的研究，包括主动、长期的随访，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，我们的调查将从纽约地区的多个地点招募正在戒毒的阿片类药物滥用者。所有参与者都将接受标准的阿片类药物过量教育培训，并在目睹他人服用过量或自己服用过量时随身携带纳洛酮。三分之一的参与者将被随机接受额外的深入心理社会教育，重点是识别和预防阿片类药物过量，以及纳洛酮的适当使用。另外三分之一的参与者将接受广泛的培训，并需要让配偶、伴侣、亲戚或朋友参与这项补充干预。我们期望这些社会心理干预措施（广泛的培训和对重要的其他人的培训）将改善药物过量的结果措施。我们还预计纳洛酮相关不良事件的发生率将降至最低，并且获得纳洛酮不会显着改变药物使用模式。这项研究的结果应该对美国这种新颖做法的风险和收益提供第一个前瞻性和系统性的评估，并教育该领域我们如何改进当前的做法。除了进行前瞻性研究外，我们还建议通过检查纽约市 DOHMH 收集的数据，对纳洛酮使用过量教育和培训的总体影响进行回顾性分析。具体来说，将比较具有提供过量预防培训设施的社区和不提供纳洛酮的设施的社区的致命和非致命阿片类药物过量率。我们预计，在提供阿片类药物过量预防培训和纳洛酮的社区，致命的阿片类药物过量发生率将显着降低。