Take-home emergency naloxone to prevent heroin overdose deaths after prison release: rationale and practicalities for the N-ALIVE randomized trial.
Take-home emergency naloxone to prevent heroin overdose deaths after prison release: rationale and practicalities for the N-ALIVE randomized trial.
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带回家的紧急纳洛酮可预防出狱后海洛因过量死亡：N-ALIVE 随机试验的基本原理和实用性。
DOI：
10.1007/s11524-013-9803-1
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Strang J
中科院分区：
文献类型：
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作者：
Strang J
纳洛酮研究（N-ALIVE）随机试验于2012年5月在英国开始，初步阶段涉及5，600名获释囚犯。该试验正在调查是否可以通过事先提供纳洛酮的带回家紧急供应来预防海洛因过量死亡。海洛因通过阿片剂引起的呼吸抑制，在吸毒死亡中所占比例过高。带回家的紧急纳洛酮是一种新的预防措施，社区计划的初步报告令人鼓舞。吸毒过量通常是可以看到的，吸毒者本人和家庭成员是一支庞大的干预队伍，他们愿意干预，但目前他们的反应往往效率低下或错误。大约10%的紧急纳洛酮被认为用于随后的紧急复苏，但迄今为止，还没有明确的研究。从监狱释放后的这段时间是死亡率极高的时期，在释放后的头两周内，海洛因过量死亡人数增加了七倍多。在有海洛因注射史的囚犯中，每200人中就有1人在出狱后的前4周内死于海洛因过量。有重大的科学和后勤挑战，以评估带回家纳洛酮的影响。即使在最近释放的囚犯中，海洛因过量死亡也是相对罕见的事件：因此，大量囚犯需要进入试验，以评估带回家的纳洛酮是否显著降低过量死亡率。N-ALIVE试验的试点阶段的开始是向前迈出的重要一步，囚犯被随机分配到常规治疗或常规治疗加带回家的紧急纳洛酮供应。随后的全面N-ALIVE试验（取决于成功的试点）将涉及56，000名获释囚犯，并将对现实世界中的应用所挽救的生命给出明确的结论。倡导者呼吁执行，而反对者则提出关切。这个问题不需要更多的公开辩论;它需要良好的科学。
The naloxone investigation (N-ALIVE) randomized trial commenced in the UK in May 2012, with the preliminary phase involving 5,600 prisoners on release. The trial is investigating whether heroin overdose deaths post-prison release can be prevented by prior provision of a take-home emergency supply of naloxone. Heroin contributes disproportionately to drug deaths through opiate-induced respiratory depression. Take-home emergency naloxone is a novel preventive measure for which there have been encouraging preliminary reports from community schemes. Overdoses are usually witnessed, and drug users themselves and also family members are a vast intervention workforce who are willing to intervene, but whose responses are currently often inefficient or wrong. Approximately 10% of provided emergency naloxone is thought to be used in subsequent emergency resuscitation but, as yet, there have been no definitive studies. The period following release from prison is a time of extraordinarily high mortality, with heroin overdose deaths increased more than sevenfold in the first fortnight after release. Of prisoners with a previous history of heroin injecting who are released from prison, 1 in 200 will die of a heroin overdose within the first 4 weeks. There are major scientific and logistical challenges to assessing the impact of take-home naloxone. Even in recently released prisoners, heroin overdose death is a relatively rare event: hence, large numbers of prisoners need to enter the trial to assess whether take-home naloxone significantly reduces the overdose death rate. The commencement of pilot phase of the N-ALIVE trial is a significant step forward, with prisoners being randomly assigned either to treatment-as-usual or to treatment-as-usual plus a supply of take-home emergency naloxone. The subsequent full N-ALIVE trial (contingent on a successful pilot) will involve 56,000 prisoners on release, and will give a definitive conclusion on lives saved in real-world application. Advocates call for implementation, while naysayers raise concerns. The issue does not need more public debate; it needs good science.