Overdose Risk Management and Compensation in the Era of Naloxone

纳洛酮时代的过量风险管理和补偿

基本信息

批准号：
10004601
负责人：
Alexander S Bennett
金额：
$ 74.79万
依托单位：
NEW YORK UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-06-01 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10004601
关键词：
Address Adult Age Alcohol or Other Drugs use Area Attitude Awareness Behavior Behavior Therapy Behavioral Cessation of life Cities Cost Savings Data Collection Development Diagnosis Drug usage Education Education and Outreach Educational Curriculum Emergency Medical Technicians Emergency Situation Enrollment Ensure Ethics Ethnic Origin Ethnography Event Exposure to Failure Female Financial compensation Foundations Funding Future Geographic state Health Health Benefit Heart Heroin Human Resources Individual Injecting drug user Intention Intervention Investigation Knowledge Learning Life Measurable Mental Health Methods Military Personnel Naloxone Naloxone Training National Institute of Drug Abuse Neighborhoods New York City Opiate Addiction Opioid Opioid abuser Overdose Participant Patient Self-Report Pattern Perception Pharmaceutical Preparations Pharmacologic Substance Pharmacy facility Play Police Prevention education Prevention program Process Psychosocial Factor Public Domains Public Health Published Comment Recording of previous events Reporting Research Respondent Risk Risk Behaviors Risk Management Risk Reduction Risk-Taking Role Sampling San Francisco Severities Statutes and Laws Subgroup Surveys Testing Text Messaging Time Training Training Programs Treatment/Psychosocial Effects United States Ursidae Family Veterans base career catalyst cost design experience first responder heroin use high risk behavior illicit opioid insight interest male news opioid epidemic opioid overdose opioid use opioid use disorder opioid user outreach overdose prevention overdose risk prescription opioid prescription opioid misuse psychosocial public health relevance recruit response safety net social social culture social structure success tool uptake willingness

项目摘要

ABSTRACT As alarming rates of opioid-related overdose have come to dominate the national dialogue on drug-related harms, the overdose reversal medication naloxone has expanded from the confines of emergency medical personnel to the public domain. The rapid legislative response of many US states to the current epidemic of opioid dependence and overdose has resulted in widespread initiatives to provide naloxone not only to professional first-responders, but also to active opioid users. These initiatives have already demonstrated their worth and are responsible for thousands of overdose reversals and lives saved. To date, however, two important topic areas that bear on the ongoing success of overdose education and naloxone distribution efforts remain unexplored. The first concerns potential gaps in knowledge about and access to naloxone among people who use opioids but are not connected to opioid overdose prevention programs where the bulk of outreach is conducted. The second concerns the largely unexplored behavioral and psychosocial effects of surviving or “reversing” an overdose in which naloxone was administered and of simply having naloxone present while engaging in overdose risk behaviors. Preliminary evidence suggests that these impacts may involve different trajectories depending on individual and social-structural factors. For some, reversing an overdose has been reported to empower individuals to maintain safe opioid use practices. For others, naloxone provision has been met with a self-reported intention to use more opioids. Why naloxone provokes such widely varying responses, and for whom it produces the most robust health benefits, remain critically unexamined questions. To address these public health concerns, this study responds to the current NIDA and FDA mandate for “additional formative and implementation studies of naloxone distribution and overdose intervention in field settings, particularly for prescription opioid abusers.” Using a mixed-method approach designed to yield richly contextualized findings, the proposed study will recruit a sample of 600 people who use illicit opioids in New York City to: a) learn which subgroups of illicit opioid users have been trained in naloxone, used it, or had it used on them, and why some continue to refuse training; b) identify the risk-behavior impacts of using naloxone, surviving an overdose because of naloxone, or having naloxone and a trained overdose responder present when using illicit opioids; and, c) illuminate opioid users’ own perspectives on overdose risk management and naloxone’s role within that, and identify social-structural and psychosocial factors underlying both positive and negative changes in overdose risk behavior. Taken together, these objectives have the power to inform the tailoring and targeting of existing outreach and education strategies and to guide the development of new intervention tools for opioid users whose exposure to naloxone and overdose events may represent powerful turning- points in their drug use careers and catalysts for positive behavioral change.

抽象的随着阿片类药物相关的过量速度令人震惊，已经占据了与毒品有关的全国性对话危害，过量逆转药物纳洛酮已从紧急医疗的范围内扩展公共领域的人员。美国许多州对当前流行病的迅速立法回应绿核苷依赖性和过量服用导致了宽度倡议，不仅为纳洛酮提供纳洛酮专业的第一响应者，但也适用于活跃的阿片类药物用户。这些举措已经证明他们的价值，并负责成千上万的过量逆转，并挽救了生命。但是，迄今为止有两个重要的主题领域，这些领域涉及过量教育和纳洛酮分布的持续成功努力仍然出乎意料。首先涉及有关纳洛酮知识和访问的潜在差距在使用阿片类药物但与阿片类药物过量预防计划无关的人中进行了大部分外展活动。第二个涉及很大程度上意外的行为和社会心理生存或“逆转”过量服用纳洛酮的影响纳洛酮在从事过量风险行为时出现。初步证据表明这些影响可能涉及不同的轨迹，具体取决于个人和社会结构因素。对于某些人，据报道，逆转过量的方法可以使个人能够维持安全的阿片类药物使用习惯。为了其他人，纳洛酮的提供已经符合使用更多阿片类药物的自我报告意图。为什么纳洛酮挑衅如此广泛的反应，并为其产生最强大的健康益处，仍然存在批判性的问题。为了解决这些公共卫生问题，本研究对当前的NIDA和FDA授权是“纳洛酮的其他形成性和实施研究在现场设置中的分配和过量干预，特别是对于处方施虐者。” 混合方法方法旨在产生丰富的情境化发现，拟议的研究将招募样本的600人在纽约市使用非法阿片类药物的样本：a）了解哪些非法阿片类药物亚组用户已经接受了纳洛酮的培训，使用了或已将其用于他们，以及为什么有些人继续拒绝训练; b）确定使用纳洛酮的风险行为影响，因为使用非法阿片类药物时，纳洛酮或纳洛酮和训练有素的过量响应者；而且，c）阐明阿片类药物用户对过量风险管理和纳洛酮在其中的角色的看法，并确定积极变化和负面变化的社会结构和社会心理因素过量的风险行为。综上所述，这些目标有能力告知裁缝和针对现有的外展和教育策略，并指导开发新干预措施接触纳洛酮和过量事件的阿片类用户的工具可能代表强大的转弯他们的药物使用职业和催化剂的积极行为改变的要点。