Improving Equitable Access to Naloxone to Prevent Opioid Overdose Deaths Within Syringe Service Programs

改善纳洛酮的公平获取，以防止注射器服务计划中阿片类药物过量死亡

• 批准号: 10371315
• 负责人: Barrot Hopkins Lambdin
• 金额: $ 71.27万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10371315
• 关键词: Address; Affect; Area; Black Populations; Black race; Black, Indigenous, People of Color; California; Caring; Consensus; Country; Data; Dose; Drops; Effectiveness of Interventions; Event; Evidence based intervention; Goals; Health; Indigenous; Injecting drug user; Interruption; Intervention; Latinx; Latinx population; Modification; Naloxone; Needle-Exchange Programs; Opioid Antagonist; Outcome; Overdose; Participant; Penetration; Performance; Periodicity; Persons; Pilot Projects; Population; Principal Investigator; Process; Randomized; Randomized Controlled Trials; Reduce health disparities; Research; Research Personnel; Series; Services; Support System; System; Systems Analysis; Testing; Time; Training; Trust; United States; United States Dept. of Health and Human Services; United States Substance Abuse and Mental Health Services Administration; Work; arm; base; cost; cost effectiveness; cost estimate; cultural competence; design; disparity reduction; effectiveness testing; experience; health care disparity; health care service; health inequalities; implementation strategy; improve minority health; improved; mortality; opioid mortality; opioid overdose; overdose death; people of color; prevent; programs; response; screening; therapy design; treatment as usual

We propose to conduct a randomized controlled trial to test the effectiveness and cost -effectiveness of an intervention designed to increase and improve equitable naloxone distribution in 48 syringe service programs (SSPs) throughout California. In the past 5 years, opioid overdose mortality rates increased 114% among Black, 97% among Latinx, and 32% among White populations. Opioid overdose fatalities are preventable with the timely administration of naloxone, an opioid antagonist, yet our research has shown that Black and Latinx people who inject drugs (PWID) are 25% and 47% less likely, respectively, to receive naloxone than White PWID. Building on pilot work (R21DA046703; Principal Investigator: Lambdin), we will use the Systems Analysis and Improvement Approach to improve equitable access to naloxone from SSPs (SAIA-Naloxone). In our pilot study with two SSPs in California, we found that SAIA-Naloxone led to an average increase of 23 more people receiving naloxone (p<0.001) and 64 more naloxone doses bein g distributed (p<0.001) per week. We observed a 116% increase in naloxone distribution to participants who were Black, Indigenous, or People of Color (BIPOC). SAIA-Naloxone was feasible and acceptable, and it resulted in meaningful improvements in naloxone penetration. We are now proposing to test SAIA-Naloxone in a large-scale randomized controlled trial. To effectively address opioid overdoses, SSP-based naloxone programs must engage participants in a series of sequential steps including screening participants; training them in naloxone administration; distributing naloxone; and building systems that support participants to possess naloxone, use naloxone during overdose events, and obtain naloxone refills as needed. This paradigm is known as the naloxone delivery cascade. SAIA-Naloxone is a multicomponent implementation strategy designed to help SSPs identify and address weaknesses along the naloxone delivery cascade. It includes determination of drop-offs in cascade delivery, process mapping and consensus discussions to identify potential solutions, and continuous quality improvement. Our Aim 1 is to test the effectiveness of SAIA-Naloxone on improving naloxone distribution at SSPs, relative to treatment as usual. Aim 2 is to test the effectiveness of SAIA-Naloxone on improving naloxone distribution at SSPs to BIPOC participants, relative to treatment as usual. Aim 3 is to estimate the cost and cost-effectiveness of SAIA-Naloxone on improving equitable access to naloxone at syringe service programs, relative to treatment as usual. This project will directly contribute to the improvement of minority health and the reduction of health disparities. The proposed study aligns with the goals of the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration, which recognize naloxone access as our nation’s first defense to prevent opioid overdose deaths.

我们建议进行一项随机对照试验来测试一项措施的有效性和成本效益 旨在增加和改善 48 个注射器服务项目中纳洛酮公平分配的干预措施 (SSP) 在过去 5 年中，整个加州阿片类药物过量死亡率增加了 114%。 黑人、97% 的拉丁裔和 32% 的白人因阿片类药物过量死亡是可以预防的。 及时施用纳洛酮（一种阿片类拮抗剂），但我们的研究表明黑人和拉丁裔 注射吸毒者 (PWID) 接受纳洛酮的可能性分别比白人低 25% 和 47% 在试点工作（R21DA046703；首席研究员：Lambdin）的基础上，我们将使用该系统 改善从 SSP 中公平获取纳洛酮的分析和改进方法（SAIA-纳洛酮）。 我们在加利福尼亚州对两个 SSP 进行了试点研究，我们发现 SAIA-纳洛酮导致平均增加 23 更多的人接受纳洛酮 (p<0.001)，每周分发的纳洛酮剂量增加 64 剂 (p<0.001)。 我们观察到黑人、原住民或其他人参与者的纳洛酮分配增加了 116% 颜色 (BIPOC) 是可行且可接受的，并且它导致了有意义的改进。 我们现在建议对 SAIA-纳洛酮进行大规模随机对照测试。 为了有效解决阿片类药物过量问题，基于 SSP 的纳洛酮项目必须让参与者参与试验。 一系列连续步骤，包括筛选参与者；对他们进行纳洛酮管理培训； 分发纳洛酮；并建立支持参与者拥有纳洛酮的系统，并在期间使用纳洛酮 过量事件，并根据需要补充纳洛酮。这种模式被称为纳洛酮递送。 SAIA-纳洛酮是一种多组分实施策略，旨在帮助 SSP 识别和实施。 解决纳洛酮传递级联中的弱点，包括确定级联中的脱落情况。 交付、流程映射和共识讨论，以确定潜在的解决方案和持续的质量 我们的目标 1 是测试 SAIA-纳洛酮在改善纳洛酮分布方面的有效性。 SSP，相对于通常的治疗，目标 2 是测试 SAIA-纳洛酮改善的有效性。 相对于常规治疗，纳洛酮在 SSP 中向 BIPOC 参与者的分布情况 目标 3 是估计 SAIA-纳洛酮在改善注射器服务中纳洛酮的公平获取方面的成本和成本效益 计划，相对于通常的待遇，该项目将直接有助于改善少数民族。 拟议的研究与该部门的目标一致。 卫生与公众服务部以及药物滥用和心理健康服务管理局， 认识到纳洛酮的使用是我们国家防止阿片类药物过量死亡的首要防御措施。