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

描述（由申请人提供）：海洛因过量是导致海洛因使用者过早死亡的主要原因（Smyth et al., 2007），也是纽约市导致中毒死亡的第二大常见药物。2005年至2009年期间，纽约市因非故意药物过量而导致的死亡总体下降了24%，但在同一时期，处方阿片类药物死亡增加了20% （Epi数据简报，纽约市卫生和精神卫生部（NYC DOHMH）， 2011年）。一种新的减少危害方法试图通过教育使用者认识阿片类药物的症状和使用纳洛酮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，我们将试图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，以提高对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，以更好地确定与该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解毒的阿片类药物滥用者。所有参与者都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自己过量服用。三分之一的参与者将被随机分配，接受额外的深入社会心理教育，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，并要求配偶、伴侣、亲戚或朋友参与这种补充干预。我们期望这些社会心理干预措施（广泛的培训和重要的其他培训）将改善药物过量的结果测量。我们还预计，纳洛酮相关不良事件的发生将是最小的，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为美国这种新做法的风险和收益提供第一个前瞻性和系统的评估，并教育该领域如何改进当前的做法。除了进行前瞻性研究外，我们还建议通过检查纽约市DOHMH收集的数据，对纳洛酮使用过量教育和培训的总体影响进行回顾性分析。具体而言，将比较社区中提供过量预防培训和纳洛酮的设施与不提供纳洛酮的设施的致命性和非致命性阿片类药物过量率。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著降低。

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.