Overdose Risk Assessment, Counseling and Naloxone Prescription in Health Care

描述(申请人提供)：药物类阿片类药物造成的致命意外中毒在过去十年中增加了三倍多，达到流行的程度。纳洛酮是美国食品和药物管理局批准的一种有效的阿片类解毒剂，通常由急救人员在紧急情况下使用，以逆转阿片类药物中毒引起的呼吸抑制。社区减少伤害组织在一些州为海洛因和非法药物阿片使用者制定了有效的过量教育和纳洛酮分发方案。向服用处方阿片类药物的患者广泛开出带回家使用的纳洛酮处方，可能会通过早期治疗防止过量死亡。大型卫生保健系统中的初级保健环境为许多有风险的人提供了接触的机会 对于阿片类药物过量，特别是高剂量阿片类药物的个人。在初级保健环境中，可以识别有风险的患者，并就过量风险提供咨询，改善临床医生和患者之间关于阿片类药物风险的沟通。初级保健提供者也可以开纳洛酮的处方。在这项研究中，我们将检查开出带回家使用的纳洛酮的关键障碍和促进者，并开发和试点测试在初级保健环境中分娩的过量风险评估、咨询和纳洛酮处方干预。这项研究将开发一种可行的、信息技术支持的过量用药预防干预措施，用于大型医疗保健系统。我们将获得关键的初步数据，以支持未来来自三个不同医疗系统的患者和提供者进行的这种干预的大规模、多地点随机对照试验：学术医疗中心、管理性医疗组织和安全网医院系统。干预措施将针对在初级保健中照顾高风险慢性处方阿片类药物使用者的医疗临床医生，包括普通医疗和艾滋病毒诊所。我们的具体目标是：(1)评估三个卫生保健系统的患者、临床医生、药剂师和临床管理人员对预防过量用药和纳洛酮处方的知识、态度和信念。通过访谈和焦点小组，我们将确定过量使用风险评估、咨询和纳洛酮处方的障碍和促进者。(2)制定有效的过量用药风险评估、咨询和纳洛酮处方干预，以便在不同的初级保健实践中分娩。(3)试行纳洛酮处方干预的随机对照试验，其中包括过量用药风险评估和咨询，并确定其对给患者开出的纳洛酮处方数量的影响。这项混合方法研究是对联邦关于扩大纳洛酮使用范围的研究的响应，以及NIDA对干预措施预防药物相关伤害的兴趣。这些目标加在一起，将导致开发一种新的干预措施，有可能减少药物阿片类药物过量造成的死亡。

DESCRIPTION (provided by applicant): Fatal unintentional poisonings from pharmaceutical opioids have increased more than three-fold in the last decade, reaching epidemic proportions. Naloxone is an effective, Food and Drug Administration approved opioid antidote usually administered by first responders in emergency settings to reverse respiratory depression due to opioid poisoning. Community-based harm reduction organizations have developed effective overdose education and naloxone distribution programs for heroin and illicit pharmaceutical opioid users in a number of states. Widespread prescribing of naloxone for take-home use to patients on prescription opioids may prevent overdose deaths through earlier treatment. Primary care settings in large health care systems, offer the opportunity to reach many individuals at risk for opioid overdose, particularly individuals on high dose opioids. In the primary care setting, patients at risk can be identified and can be counseled on overdose risk, improving communication between clinicians and patients about the risks of opioids. Primary care providers can also prescribe naloxone. In this study we will examine the key barriers and facilitators to prescribing naloxone for take-home use and develop and pilot test an overdose risk assessment, counseling and naloxone prescription intervention for delivery in primary care settings. This study will develop a feasible, information-technology supported overdose prevention intervention for use in large health care systems. We will obtain key preliminary data to support a future large scale, multi-site randomized controlled trial of this intervention from patients and providers in three distinct health systems: an academic medical center, a managed care organization, and a safety net hospital system. The intervention will be targeted to medical clinicians who care for high-risk chronic prescription opioid users in primary care, including general medical and HIV clinics. Our Specific Aims are to: (1) Assess the knowledge, attitudes and beliefs about overdose prevention and naloxone prescription among patients, clinicians, pharmacists and clinical administrators in three health care systems. Through interviews and focus groups, we will determine the barriers and facilitators to overdose risk assessment, counseling and naloxone prescription for take-home use. (2) Develop an efficient overdose risk assessment, counseling and naloxone prescription intervention for delivery in diverse primary care practices. (3) Pilot test a randomized controlled trial of a naloxone prescription interventio that includes overdose risk assessment and counseling and determine its effects on the number of naloxone prescriptions delivered to patients This mixed methods study is responsive to federal calls for studies on widening access to naloxone and NIDA's interest in interventions to prevent drug-related injuries. Together, these aims will lead to the development of a novel intervention which has the potential to reduce fatalities from pharmaceutical opioid overdoses.