Developing a Prescription Opioid Overdose Prevention Intervention

描述（由申请人提供）：1999年至2010年间，美国成年人非故意过量死亡增加了173%。这一变化主要是由于致命的阿片类止痛药过量使用的增加，现在大大超过了海洛因过量使用造成的死亡人数。对于那些有物质使用障碍（SUDs）的人来说，过量是死亡的主要原因，而在SUDs治疗后的一段时间是过量的高风险时期。非医疗使用阿片类药物在sud患者中很常见。尽管如此，对于接受SUD治疗的患者，很少有干预措施可以降低阿片类药物过量的风险。该项目将制定一项三期干预措施，以减少近期非医疗阿片类药物使用的SUD治疗个体的过量风险行为。内容将特别侧重于阿片类药物过量，并将基于：(a)动机增强，这已被发现可减少危险的酒精使用，以及(b)过量证人干预，这已被用于培训海洛因使用者对过量药物的反应。干预措施还将纳入关于降低艾滋病毒感染风险的内容，因为有机会接触到艾滋病毒感染风险较高的个人，以及艾滋病毒和过量风险行为（例如注射阿片类药物和其他药物）的重叠。在完善干预内容后，一项先导随机对照试验将提供所需的初步数据，为未来大规模评估干预效果的设计提供信息。

DESCRIPTION (provided by applicant): Unintentional overdose deaths increased 173% among U.S. adults between 1999 and 2010. This change is mostly due to increases in fatal opioid pain medication overdoses, which now greatly exceed deaths due to heroin overdose. For those with substance use disorders (SUDs), overdose is a leading cause of death, and the period after treatment for SUDs is high risk for overdose. Non-medical use of opioids is common among individuals with SUDs. Despite this, there are few interventions to reduce opioid medication overdose risk for those in SUD treatment. This project will develop a three-session intervention to reduce overdose risk behavior among individuals in SUD treatment with recent non-medical opioid use. The content will focus on opioid medication overdoses specifically, and will be based on: (a) motivational enhancement, which has been found to reduce risky alcohol use, and (b) overdose witness interventions, which have been used to train heroin users on overdose response. The intervention will also incorporate content on reducing risk of HIV infection given the opportunity to reach individuals at elevated risk for HIV and the overlap in HIV and overdose risk behaviors (e.g., injecting opioid medications and other drugs). After refining intervention content, a pilot randomized controlled trial will provide the preliminary dat needed to inform the design of a future large-scale evaluation of the efficacy of the intervention. Specifically, 60 men and 60 women will be randomized to the intervention or an attention control condition. Assessments will be conducted at baseline, at the completion of intervention/control procedures, and three and six months later. The specific aims are to: (1) refine a motivational enhancement prevention intervention for prescription opioid overdose risk reduction and improved witnessed overdose response for at-risk patients in addictions treatment; (2) conduct a pilot randomized controlled trial comparing the prescription opioid overdose prevention intervention to a supportive educational control condition for patients in addictions treatment in order to: (a) obtain information about the feasibility of randomized controlled procedures; and (b) determine the distribution and variability of the primary (overdose risk behaviors) and mediating/secondary (witnessed overdose response, self-efficacy to reduce overdose risk, knowledge of overdose risk factors and symptom recognition) outcomes; and (3) determine the distribution and variability in changes in HIV risk behaviors (e.g., reductions in injection of prescription opioids) over follow-up. A secondary aim of the proposal is to examine the variation in outcomes within sub-groups of participants defined by group (intervention vs. control) and gender. This study will provide crucial initial data on an innovative new strategy to prevent prescription opioid overdoses. The project will also provide initial data on the potential for integrating overdose and HIV prevention. The public health significance of this project is amplified by the combining of strategies to reduce participants' overdose risk with strategies to improve survival for individuals who overdose in the presence of participants.