Risk and Benefits of Overdose Education and Naloxone Prescribing to Heroin Users

过量教育和向海洛因使用者开纳洛酮处方的风险和益处

• 批准号: 8694865
• 负责人: SANDRA D COMER
• 金额: $ 54.05万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8694865
• 关键词: Abstinence; Address; Adverse event; Affect; Area; Behavior; Benefits and Risks; Cessation of life; Data; Data Analyses; Drug Combinations; Drug Metabolic Detoxication; Drug usage; Education; Effectiveness; Effectiveness of Interventions; Emergency Situation; Frequencies; Friends; Funding; Grant; Harm Reduction; Health; Health Personnel; Heroin; Heroin Users; Human Resources; Illicit Drugs; Imprisonment; Incentives; Individual; Instruction; Intervention; Investigation; Knowledge; Location; Measures; Medical; Mental Health; Methods; Modification; Naloxone; Narcotic Antagonists; Needle-Exchange Programs; Neighborhoods; New York City; Opioid; Outcome; Outcome Measure; Overdose; Participant; Patient Self-Report; Pattern; Persons; Pharmaceutical Preparations; Poisoning; Population; Premature Mortality; Prevalence; Prevention; Prevention program; Prospective Studies; Public Health; Randomized; Recording of previous events; Recruitment Activity; Relative (related person); Reporting; Research; Resuscitation; Retrospective Studies; Review Literature; Risk-Benefit Assessment; Safety; Sedation procedure; Services; Site; Sodium Chloride; Solutions; Spouses; Symptoms; Techniques; Time; Training; Training Programs; Training and Education; Ventilatory Depression; Water; design; experience; follow-up; heroin overdose; high risk; improved; mortality; novel; novel strategies; opioid abuse; overdose death; overdose prevention; prescription opioid; programs; prospective; psychosocial; public health relevance; response; substance abuser; treatment as usual

DESCRIPTION (provided by applicant): Heroin overdose is the leading cause of premature mortality among heroin users (Smyth et al., 2007), and is the second most common drug responsible for poisoning deaths in New York City. Although deaths due to unintentional drug overdose decreased overall by 24% in NYC between 2005 and 2009, prescription opioid deaths increased by 20% during this same time period (Epi Data Brief, New York City Department of Health and Mental Hygiene (NYC DOHMH), 2011). A new harm reduction approach attempts to decrease opioid overdose by educating users in recognizing its symptoms and in using naloxone to reverse opioid-induced respiratory depression. In the proposed studies, we will attempt to obtain data on the impact that these programs may have on the health and outcomes of a population of opioid users at high risk for witnessing and experiencing an opioid overdose. We have preliminary evidence supporting the need for modifications of existing training programs to improve accurate identification of opioid overdose. Furthermore, a review of the literature has revealed that more extensive research, including proactive, long-term follow-up, is needed to better identify all of the benefits and risks associated with this approach. Specifically our investigation will recruit ongoing and recently detoxified opioid abusers from several sites throughout the NYC area. All participants will receive standard opioid overdose education training and naloxone to carry should they witness another person experiencing an overdose, or overdose themselves. One-third of the participants will be randomized to receive additional in-depth psychosocial education focusing on recognition and prevention of opioid overdose, and appropriate use of naloxone. Another one-third of the participants will receive the extensive training and be required to engage a spouse, partner, relative, or friend in this supplementary intervention. We expect that these psychosocial interventions (extensive training and training of a significant other) will improve overdose outcome measures. We also expect that the occurrence of naloxone-related adverse events will be minimal, and that access to naloxone will not significantly alter drug use patterns. The results of this study should provide one of the firs prospective and systematic assessments of the risks and benefits of this novel practice in the U.S., and educate the field on how we may improve upon current practices. In addition to conducting a prospective study, we also propose to conduct a retrospective analysis of the overall impact of overdose education and training in the use of naloxone by examining data collected by the NYC DOHMH. Specifically, both fatal and non-fatal opioid overdose rates will be compared in neighborhoods with facilities that offer overdose prevention training and naloxone to those that do not. We anticipate that the prevalence of fatal opioid overdose will be significantly lower in neighborhoods where opioid overdose prevention training and naloxone are offered.

描述（由申请人提供）：海洛因过量是海洛因使用者过早死亡的主要原因（Smyth等人，2007年），并且是纽约市中毒死亡的第二大常见药物。尽管2005年至2009年期间纽约市因意外药物过量导致的死亡总体下降了24%，但同一时期处方阿片类药物死亡增加了20%（Epi数据简报，纽约市卫生和心理卫生部（NYC DOHMH），2011）。一种新的减少危害的方法试图通过教育用户认识其症状和使用纳洛酮来逆转阿片类药物引起的呼吸抑制来减少阿片类药物过量。在拟议的研究中，我们将尝试获得有关这些计划可能对目睹和经历阿片类药物过量的高风险阿片类药物使用者人群的健康和结果产生影响的数据。我们有初步证据支持需要修改现有的培训计划，以提高阿片类药物过量的准确识别。此外，对文献的回顾表明，需要进行更广泛的研究，包括积极的长期随访，以更好地确定与这种方法相关的所有益处和风险。具体来说，我们的调查将从纽约地区的几个地点招募正在进行和最近戒毒的阿片类药物滥用者。所有参与者将接受标准的阿片类药物过量教育培训和纳洛酮携带，如果他们目睹另一个人经历过量，或过量自己。三分之一的参与者将随机接受额外的深入心理社会教育，重点是识别和预防阿片类药物过量以及适当使用纳洛酮。另外三分之一的参与者将接受广泛的培训，并被要求让配偶、伴侣、亲戚或朋友参与这一补充干预。我们预计这些心理干预（广泛的培训和重要他人的培训）将改善过量结局指标。我们还预计纳洛酮相关不良事件的发生率将是最低限度的，并且获得纳洛酮不会显著改变药物使用模式。这项研究的结果应该是对这种新做法在美国的风险和益处的第一次前瞻性和系统性评估之一，并教育该领域如何改进当前的实践。除了进行前瞻性研究外，我们还建议通过检查NYC DOHMH收集的数据，对过量教育和培训对纳洛酮使用的总体影响进行回顾性分析。具体来说，致命和非致命阿片类药物过量率将在社区进行比较，这些社区的设施提供过量预防培训和纳洛酮。我们预计，在提供阿片类药物过量预防培训和纳洛酮的社区，致命阿片类药物过量的患病率将显着降低。