Preventing Opioid Overdose Mortality in the United States

预防美国阿片类药物过量死亡

• 批准号: 9922273
• 负责人: Barrot Hopkins Lambdin
• 金额: $ 42.54万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9922273
• 关键词: Address; Adoption; Age; California; Communities; Community Surveys; Country; County; Cross-Sectional Studies; Data; Effectiveness; Epidemic; Epidemiologist; Evidence based intervention; Guidelines; HIV; Improve Access; Intervention; Knowledge; Manuals; Medical; Naloxone; Needle-Exchange Programs; Overdose; Persons; Phase; Preparation; Prevalence; Principal Investigator; Problem Solving; Process; Randomized; Randomized Controlled Trials; Research; Research Personnel; Resources; Sampling; Scientist; Service setting; Specialist; Surveys; Techniques; Testing; United States; Work; arm; base; effectiveness evaluation; effectiveness testing; evidence base; experience; experimental arm; falls; follow-up; heroin use; high risk; implementation science; implementation strategy; improved; interest; mortality; opioid overdose; overdose risk; prevent; programs; response; sociologist; systematic review

We propose an R01 study by a new, early stage investigator that seeks to understand and improve naloxone implementation within syringe service programs (SSPs) to reduce opioid overdose mortality in the United States. The age-adjusted opioid overdose mortality rate rose nearly 200% from 2000 to 2014 and increased another 16% from 2014 to 2015. These data indicate that the opioid overdose epidemic continues to surge in the United States. Naloxone is an evidence-based biomedical intervention that reverses opioid overdose, effectively preventing opioid overdose mortality. The study team has developed an implementation manual for naloxone implementation in various settings including SSPs. Yet, only 15% of U.S. counties with the highest overdose mortality levels have a community-based, naloxone program operating within them. Furthermore, only 56% of SSPs, one of the best venues through which to implement this intervention, have implemented naloxone. A nuanced understanding of where naloxone delivery within SSPs falls along the four phases of the implementation process—from Exploration and Preparation to Implementation and Sustainment (EPIS)—is critical to focus intervention efforts. A recent systematic review concluded that dissemination alone is necessary but often insufficient to advance the desired adoption of interventions. There is, therefore, an urgent need to empirically identify implementation strategies that can significantly improve upon dissemination approaches. One such strategy—external facilitation—has demonstrated effectiveness in medical settings, but no research has experimentally tested its use to improve delivery of a biomedical intervention in community- based organizations such as SSPs. We propose an external facilitation intervention, shown to improve implementation in HIV service settings, to identify barriers to and needs for and facilitate start-up of naloxone delivery within SSPs. Aim 1 is to characterize U.S. SSPs along the exploration, preparation, implementation, and sustainment continuum for delivering the naloxone intervention. Aim 2 is to test the effectiveness of external facilitation to improve the advancement of the naloxone intervention along the EPIS continuum among U.S. SSPs compared with dissemination of the implementation manual alone. To achieve Aim 1, we will conduct a cross-sectional study with all SSPs (N=275) throughout the United States. To achieve Aim 2, we will conduct a randomized controlled trial with the following arms: (1) dissemination of an implementation manual and external facilitation for 12 months (experimental arm) and (2) dissemination of an implementation manual only (control arm). All SSPs not yet implementing naloxone and interested in participating (estimated N = 100) will be randomly assigned in a 1:1 ratio to the study arms. Advancement of naloxone along the EPIS continuum will be assessed via surveys 12 months post randomization. Together, these efforts can improve access to naloxone for people at high risk of overdose, thereby improving our nation's response to the opioid overdose epidemic.

我们提议由一位新的早期研究人员进行 R01 研究，旨在了解和改进 在注射器服务计划（SSP）中使用纳洛酮以降低阿片类药物过量死亡率 美国，从 2000 年到 2014 年，按年龄调整的阿片类药物过量死亡率上升了近 200%。 2014 年至 2015 年又增加了 16%。这些数据表明阿片类药物过量流行病仍在继续 纳洛酮是一种基于证据的生物医学干预措施，可以逆转阿片类药物的使用。 研究小组制定了一项实施方案，有效预防阿片类药物过量死亡。 然而，只有 15% 的美国县制定了纳洛酮在包括 SSP 在内的各种环境中实施的手册。 服药过量死亡率最高的地方有一个以社区为基础的纳洛酮方案。 此外，只有 56% 的 SSP（实施这一干预措施的最佳场所之一）已经采取了措施。 详细了解 SSP 中纳洛酮的递送方式在四个方面的分布。 实施过程的各个阶段——从探索和准备到实施和维持 (EPIS)——最近的一项系统审查得出的结论是，仅传播就至关重要。 是必要的，但往往不足以推动预期的干预措施的采用。 迫切需要根据经验确定可在传播后显着改进的实施战略 其中一种策略——外部促进——已在医疗环境中证明是有效的，但是 没有研究通过实验测试其在改善社区生物医学干预方面的用途。 我们建议采取外部促进干预措施，事实证明可以改善这种情况。 在艾滋病毒服务机构中实施，以确定纳洛酮的障碍和需求并促进纳洛酮的启动 目标 1 是描述美国 SSP 的探索、准备、实施、 目标 2 是测试纳洛酮干预的有效性。 外部促进，以提高纳洛酮干预在 EPIS 连续体中的进展 美国 SSP 与单独传播实施手册的比较 为了实现目标 1，我们将。 对美国所有 SSP (N=275) 进行横断面研究 为了实现目标 2，我们将。 通过以下方式进行随机对照试验：(1) 分发实施手册 12 个月的外部促进（实验组）以及 (2) 传播实施手册 仅（对照组）。所有尚未实施纳洛酮且有兴趣参与的 SSP（估计 N = 100） 将按照 1:1 的比例随机分配到 EPIS 中纳洛酮的研究组。 连续性将通过随机化后 12 个月的调查进行评估，这些努力可以得到改善。 为服用过量的高风险人群提供纳洛酮，从而改善我们国家对阿片类药物的反应 过量流行。