Development and Validation of a Computerized Opioid Overdose Intervention

描述（由申请人提供）：摘要非故意致死性药物过量（OD）现在是一般人群意外死亡的第二大原因。1999年至2008年间，阿片类镇痛药致死性OD增加了400%以上，非致死性过量的发生率比致死性OD高3 - 7倍（1 - 4）。非故意阿片类药物OD是多个社会人群的公共卫生危机，包括吸毒者、接受慢性疼痛治疗的患者、老年人、青少年和儿童（1 - 3; 6 - 10）。教育干预 已经开发了这些干预措施，以增加关于阿片类药物OD风险因素、症状和适当反应的知识，但是，尚未对这些干预措施进行随机对照评价。受试者内评估报告参与者的知识和行为变化（13 - 17）的立即和持续的增长，但这些计划受到限制，可能会限制其广泛传播。因此，迫切需要制定一种阿片类药物滥用教育干预措施，使广大受众能够获得，并以易于管理和具有成本效益的方式立即和持续地获得知识。我们在为吸毒者开发计算机化培训课程方面拥有专业知识，并建议使用我们集团开发的创新和专有计算机培训计划，以创建一个基于网络的，计算机化的，互动的阿片类药物OD教育培训计划，该计划将纳入多媒体学习组件和流畅性培训，以获得知识。该提案是NIDA行为疗法开发计划的R21和第1阶段早期疗法开发提案。本研究的第1阶段将开发一个计算机化的阿片类药物OD预防计划，该计划结合了直接指导和操作性条件反射的特点，以促进立即和持续的知识获得。第2阶段将是对干预措施与两种对照干预措施进行随机对照评价。参与者将从短暂的住院戒毒中招募（n = 60），在完成戒毒后立即接受干预，并将完成2次随访访视，以评估持续的知识。主要结局将是干预前后以及1个月和3个月随访访视时进行的知识测试相对于基线的百分比变化。次要结果将包括自我报告的行为变化和参与者对干预的接受程度。这项研究的基本原理和公共卫生效益不能低估-该项目将提供一个简短的，医学支持的干预措施，可以在数百种环境中快速，轻松地管理（例如，治疗中心、监狱和拘留所、针具交换中心、初级保健办公室、学校），以及不同的患者群体（例如，吸毒者、慢性疼痛患者、老年人、学生、儿童、父母）。这些结果预计将产生积极的影响，因为它们将提供廉价，易于管理的干预策略，这将有助于减少目前阿片类药物OD的全国流行，并将扩大计算机化干预的使用，以更广泛地解决公共卫生问题。

DESCRIPTION (provided by applicant): ABSTRACT Unintentional fatal drug overdose (OD) is now the 2nd leading cause of accidental death in the general population. Fatal OD from opioid analgesics specifically has increased over 400% between 1999 and 2008, and nonfatal overdose occurs at a rate 3-7 greater than fatal OD (1-4). Unintentional opioid OD is a public health crisis in several societal populations including drug users, patients being treated for chronic pain, elderly individuals, adolescents, and children (1-3; 6-10). Educational interventions have been developed to increase knowledge regarding opioid OD risk factors, symptoms, and appropriate responses, however, no randomized controlled evaluations of these interventions have been conducted. Within-subject evaluations report immediate and sustained increases in participant knowledge and behavior change (13-17), yet these programs suffer from limitations that may limit their widespread dissemination. Thus, there is an urgent, critical need to develop an opioid OD educational intervention that can be accessed by a broad audience, and produces immediate and sustained gains in knowledge in an easily administered and cost-effective way. We have expertise in developing computerized training curriculum for drug users and are proposing to use an innovative and proprietary computer training program developed by our group to create a web-based, computerized, interactive, opioid OD education training program that will incorporate multi-media learning components and fluency training to produce knowledge gains. This proposal is an R21 and a Stage 1 Early Therapy Development proposal for the NIDA Behavioral Therapies Development Program. Phase 1 of this study will be to develop a computerized opioid OD prevention program that incorporates features of direct instruction and operant conditioning to promote immediate and sustained knowledge gain. Phase 2 will be a randomized, controlled evaluation of the intervention against two control interventions. Participants will be recruited from a brief inpatient detoxification (n=60), will receive the intervention immediately upon completing the detoxification, and will complete 2 follow-up visits to evaluate sustained knowledge. The primary outcome will be percent change from baseline on a knowledge test that is administered pre and post intervention, and at the 1 and 3 month follow-up visits. Secondary outcomes will include self-reported behavior change and participant acceptance of the intervention. The rationale and public health benefit of this research cannot be understated- this project will make available a brief, empirically-supported intervention that can be administered quickly and easily within hundreds of settings (e.g., treatment centers, prisons and jails, needle exchange centers, primary care offices, schools), and to diverse patient populations (e.g., drug users, chronic pain patients, elderly, student, children, parents). These outcomes are expected to have a positive impact because they will provide cheap, easily-administered intervention strategy that will help reduce the current national epidemic of opioid OD, and will expand the use of computerized interventions to address public health issues more broadly.