Evaluating naloxone-on-release from incarceration as community overdose prevention

评估出狱后纳洛酮作为社区用药过量预防的作用

• 批准号: 10643858
• 负责人: Peter John Davidson
• 金额: $ 73.95万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10643858
• 关键词: Accidents; Address; African American; Area; Black race; Cessation of life; Characteristics; Cohort Studies; Communities; County; Criminal Justice; Cross-Sectional Studies; Data; Data Analyses; Death Rate; Diffusion of Innovation; Dose; Drops; Drug usage; Equity; Ethnic Origin; Exposure to; General Population; Goals; Grant; Imprisonment; Individual; Intervention; Interview; Jail; Knowledge; Latinx population; Literature; Los Angeles; Methods; Naloxone; Needle-Exchange Programs; Opioid Antagonist; Outcome; Overdose; Overdose reduction; Overdose reversal; Paper; Persons; Pharmaceutical Preparations; Policies; Population; Program Description; Provider; Public Health; Race; Recording of previous events; Risk; Sampling; Scotland; Self Administration; Surveys; System; Training; Underserved Population; United States; Work; cohort; cost; cost effective; design; experience; high risk; high risk population; innovation; interest; mortality; mortality risk; opioid mortality; opioid overdose; opioid use; opioid user; overdose death; overdose education; overdose prevention; overdose risk; programs; recruit; response; social; underserved community

Project Summary The overarching goal of this study is to evaluate a high-volume, low-threshold, naloxone-on-release program serving individuals being released from the Los Angeles County Jail system. Opioid-related overdose death is the single largest cause of accidental death in the United States. Individuals being released from incarceration are at particular risk, with some studies showing their risk of death in the weeks immediately after release is as much as 129 times that of the general population. One intervention demonstrated to reduce opioid-related deaths is training opioid users and those in their immediate social circles to recognize overdose and to respond by using naloxone, an opioid antagonist which effectively ‘reverses’ overdose. Overdose Education and Naloxone Distribution (OEND) programs are now present in almost every state. However, access to OEND programs has not been equitable, with African American and Latinx people who use opioids being less likely to access OEND, a particular concern given opioid-related overdose mortality has increased 114% among Black and 97% among Latinx populations over the last 5 years compared to 32% among Whites. One recent innovation, ‘naloxone-on-release’, aims to address the particularly high rate of overdoses experienced by individuals being released from incarceration. In addition, naloxone-on-release has the potential to reach populations underserved by traditional OEND programs given the over-representation of African American and Latinx people in incarcerated populations nationwide. At least 28 pilot or early stage naloxone-on-release programs currently exist in the US, however to date the literature on these programs is largely limited to descriptions of feasibility and logistical issues. A single paper describes the efficacy of a national-level program in Scotland, which, encouragingly, saw a 36% drop in the proportion of overdose deaths among releasees in the four weeks following release. In January 2020 the Los Angeles Sheriff’s Department implemented a naloxone-on-release program, in which all inmates being released from the LA County Jail system are exposed to a video training on overdose recognition and response and are able to take as many doses of naloxone as they wish from a no-cost vending machine at the point of release. 31,352 doses of naloxone were distributed by the program in 2020, almost twice as much as every other OEND program in Los Angeles combined, and making it by far the largest such program in the world (the Scottish program described above distributed 2,273 doses over 3 years). We will use an innovative mixed-methods design to capitalize on this timely opportunity, and examine whether the naloxone-on-release program is serving those most at risk, whether the program reaches previously underserved populations, how the program impacts the communities to which releasees return, and whether the program reduces deaths among releasees and in the communities to which they return.

项目概要 本研究的总体目标是评估大容量、低阈值的纳洛酮释放计划 为从洛杉矶县监狱系统释放的人员提供服务。 阿片类药物相关过量死亡是美国意外死亡的最大单一原因。 从监禁中释放的个人面临着特别的风险，一些研究表明他们面临以下风险： 释放后几周内的死亡人数高达普通人群的 129 倍。 一项被证明可以减少阿片类药物相关死亡的干预措施是培训阿片类药物使用者及其使用者 立即社交圈认识到药物过量并通过使用纳洛酮（一种阿片类药物拮抗剂）来应对 有效“逆转”过量用药的教育和纳洛酮分发 (OEND) 计划现已启动。 然而，获得 OEND 计划的机会并不公平，非洲也是如此。 使用阿片类药物的美国人和拉丁裔人不太可能获得 OEND，这是一个特别令人担忧的问题 与阿片类药物过量相关的死亡率在黑人中增加了 114%，在拉丁裔中增加了 97% 过去 5 年，白人中的这一比例为 32%。最近的一项创新“纳洛酮释放”旨在 解决刑满释放人员服药过量率特别高的问题。 此外，释放纳洛酮有可能惠及传统 OEND 服务不足的人群 鉴于非裔美国人和拉丁裔在被监禁人口中所占比例过高 美国目前至少有 28 个试点或早期纳洛酮释放项目。 截至目前，有关这些计划的文献主要限于可行性和后勤问题的描述。 单篇论文描述了苏格兰一项国家级计划的功效，令人鼓舞的是，该计划的利用率为 36% 释放后四个星期内释放的药物过量死亡比例下降。 2020 年 1 月，洛杉矶治安部门实施了纳洛酮释放计划， 所有从洛杉矶县监狱系统释放的囚犯都会接受有关服药过量的视频培训 认可和反应，并能够从免费自动售货机中获取任意剂量的纳洛酮 2020 年，该计划分发了 31,352 剂纳洛酮，几乎 是洛杉矶所有其他 OEND 项目总和的两倍，使其成为迄今为止最大的此类项目 世界上的计划（上述苏格兰计划在 3 年内分发了 2,273 剂疫苗）。 我们将使用创新的混合方法设计来利用这个及时的机会，并检查 纳洛酮释放计划是否为高危人群提供服务，该计划是否达到 以前服务不足的人群，该计划如何影响释放物返回的社区，以及 该计划是否减少释放者及其返回社区的死亡人数。