Evaluation of Overdose Prevention Programs for Injection Drug Users

注射吸毒者过量预防方案的评价

• 批准号: 7686401
• 负责人: Stephen E Lankenau
• 金额: $ 19.94万
• 依托单位: CHILDREN'S HOSPITAL OF LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7686401
• 关键词: Acquired Immunodeficiency Syndrome; Address; Affect; Area; Behavior; Blood-Borne Pathogens; Capital; Caring; Case Management; Cessation of life; Characteristics; Communities; Consumption; Data Reporting; Drug Metabolic Detoxication; Drug usage; Enrollment; Environment; Evaluation; Folk Remedy; Frequencies; Fright; Geographic Locations; HIV; HIV Infections; Health behavior; Healthcare; Heroin; Homelessness; Injecting drug user; Injection of therapeutic agent; Interview; Intravenous; Legal; Length; Life; Literature; Location; Los Angeles; Medical; Methods; Naloxone; Names; Narcotic Antagonists; Needle-Exchange Programs; Opioid; Outcome; Overdose; Participant; Patient Self-Report; Pattern; Pharmaceutical Preparations; Police; Population; Prevalence; Prevention; Prevention program; Protocols documentation; Public Health; Qualitative Methods; Recruitment Activity; Reporting; Risk; Risk Behaviors; Role; Route; Sampling Studies; Services; Social Network; Syringes; Techniques; Testing; Training; Training Programs; Translating; Work; base; behavior change; design; heroin overdose; mortality; overdose prevention; programs; psychologic; public health relevance; response; skills; social; social capital

DESCRIPTION (provided by applicant): Drug overdose is the single greatest cause of mortality among injection drug users (IDUs) in the U.S. Fatal heroin overdoses cause more than half of all deaths among IDUs, which far exceeds the proportion of deaths due to AIDS or other causes. Administration of heroin or other opiods via intravenous route not only increases the risk for HIV and other blood-borne pathogens, but also significantly increases the risk a of potentially fatal overdose. Therefore, IDUs are a population at elevated risk for both HIV infection and fatal drug overdose. A heroin overdose can be safely reversed with the administration of naloxone (brand name Narcan) - a legal, nonscheduled opioid antagonist. Naloxone is currently prescribed and distributed by overdose prevention programs (OPP) in 15 states. Despite the common-sense notion that these programs "work," scientifically designed evaluations of OPPs are almost non-existent, and outcomes are still poorly defined. The proposed study is designed to investigate changes in overdose response and other drug-related health behaviors among IDUs participating in two OPPs in Los Angeles. The study will address the following three specific aims: observe changes in overdose response behavior among IDUs; examine whether participating in overdose prevention training or overdose response (i.e. performing a "rescue") affects other drug-related health behaviors; and investigate structural, social, and psychological barriers towards enrolling IDUs into OPPs. The proposed study will use qualitative and quantitative methods to study samples of IDUs recruited from two community-based programs in Los Angeles that conduct overdose prevention training - Homeless Health Care Los Angeles (HHCLA) and Common Ground (CG). Quantitative baseline and "incident report" data will be collected as part of an existing protocol started in November, 2008, to document behaviors in response to witnessed overdoses and circumstances precipitating requests for refills of naloxone. Qualitative in-depth interviews with 150 IDUs (100 trained and 50 untrained) will explore rationales for and barriers to enrolling in overdose prevention training, the effects of training participation, differences between training programs, and the effects of participating in an overdose rescue. PUBLIC HEALTH RELEVANCE: The proposed study will fill a critical gap in the public health literature on opioid overdose and the effects of OPPs among IDUs, who are at elevated risk for death due to overdose. Additionally, the study will provide important information about how the effects of participating in overdose prevention training and practicing prevention skills may be associated with non-overdose related health behaviors, such as HIV risk behavior.

描述（由申请人提供）：吸毒过量是美国注射吸毒者 (IDU) 死亡的最大单一原因。致命的海洛因过量导致注射吸毒者死亡人数的一半以上，远远超过因艾滋病或艾滋病毒死亡的比例。其他原因。通过静脉注射海洛因或其他阿片类药物不仅会增加感染艾滋病毒和其他血源性病原体的风险，还会显着增加潜在致命过量的风险。因此，吸毒者是艾滋病毒感染和致命药物过量风险较高的人群。海洛因过量服用可以通过服用纳洛酮（商品名纳洛酮）安全地逆转，纳洛酮是一种合法的非定期阿片类拮抗剂。目前，纳洛酮由过量预防计划 (OPP) 在 15 个州开处方和分发。尽管常识性的观念认为这些计划“有效”，但对 OPP 进行科学设计的评估几乎不存在，而且结果仍然不明确。拟议的研究旨在调查参加洛杉矶两个 OPP 的注射吸毒者中过量反应和其他药物相关健康行为的变化。该研究将实现以下三个具体目标：观察注射吸毒者过量反应行为的变化；检查参加过量预防培训或过量反应（即进行“救援”）是否影响其他与药物相关的健康行为；调查将注射吸毒者纳入 OPP 的结构、社会和心理障碍。拟议的研究将使用定性和定量方法来研究从洛杉矶两个进行过量预防培训的社区项目——洛杉矶无家可归者医疗中心 (HHCLA) 和 Common Ground (CG) 招募的注射吸毒者样本。定量基线和“事件报告”数据将作为 2008 年 11 月启动的现有方案的一部分进行收集，以记录针对目击过量用药和引发补充纳洛酮请求的情况的行为。对 150 名注射吸毒者（100 名接受过培训和 50 名未接受培训）的定性深入访谈将探讨参加药物过量预防培训的理由和障碍、参加培训的效果、培训计划之间的差异以及参与药物过量救援的效果。 公共卫生相关性：拟议的研究将填补公共卫生文献中关于阿片类药物过量以及 OPP 对注射吸毒者的影响的关键空白，注射吸毒者因过量服用而死亡的风险较高。此外，该研究还将提供重要信息，说明参加过量预防培训和练习预防技能的效果如何与非过量相关的健康行为（例如艾滋病毒危险行为）相关。