Overdose Risk Management and Compensation in the Era of Naloxone

摘要 随着与阿片类药物相关的过量用药的惊人发生率已成为有关毒品相关的全国对话的主导 危害，过量逆转药物纳洛酮已超出紧急医疗的范围 人员进入公共领域。美国多州针对当前疫情的快速立法应对 阿片类药物依赖和过量导致广泛采取行动，不仅向患者提供纳洛酮 专业的急救人员，也包括活跃的阿片类药物使用者。这些举措已经表明 他们的价值并为数以千计的药物过量逆转和挽救生命做出了贡献。然而，迄今为止，有两个 与过量用药教育和纳洛酮分发的持续成功有关的重要主题领域 努力仍有待探索。第一个问题涉及纳洛酮知识和获取方面的潜在差距 在使用阿片类药物但未参与阿片类药物过量预防计划的人群中， 进行了大量外展活动。第二个涉及很大程度上尚未探索的行为和心理社会 幸存或“逆转”服用纳洛酮的过量用药以及简单地服用纳洛酮的效果 纳洛酮在从事过量危险行为时出现。初步证据表明，这些 根据个人和社会结构因素，影响可能涉及不同的轨迹。对于一些人来说， 据报道，扭转过量用药可以使个人保持安全的阿片类药物使用习惯。对于 其他人则表示，纳洛酮的供应符合自我报告的使用更多阿片类药物的意图。为什么选择纳洛酮 引起如此广泛不同的反应，并且它为谁带来最强劲的健康益处，仍然 未经严格审查的问题。为了解决这些公共卫生问题，本研究回应了 当前 NIDA 和 FDA 授权“纳洛酮的额外形成和实施研究” 在现场环境中的分发和过量干预，特别是对于处方阿片类药物滥用者。”使用 混合方法旨在产生丰富的情境化发现，拟议的研究将招募 对纽约市 600 名使用非法阿片类药物的人进行抽样调查，目的是： a) 了解非法阿片类药物的哪些亚组 用户接受过纳洛酮培训、使用过纳洛酮或有人在他们身上使用过纳洛酮，以及为什么有些人仍然拒绝 培训； b) 确定使用纳洛酮的风险行为影响，由于过量服用纳洛酮而幸存下来 纳洛酮，或使用非法阿片类药物时有纳洛酮和训练有素的过量反应人员在场；以及，c) 阐明阿片类药物使用者对过量风险管理的看法以及纳洛酮在其中的作用， 并确定积极和消极变化背后的社会结构和社会心理因素 服用过量的危险行为。总而言之，这些目标有能力为剪裁和调整提供信息。 针对现有的外展和教育战略并指导新干预措施的制定 针对阿片类药物使用者的工具，他们暴露于纳洛酮和过量事件可能代表着强大的转变 他们吸毒生涯中的要点和积极行为改变的催化剂。

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.