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The Safety and Impact of Expanded Access to Naloxone in Health Systems

卫生系统扩大纳洛酮使用范围的安全性和影响

基本信息

批准号：
9920806
负责人：
Ingrid A Binswanger
金额：
$ 12.22万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-01 至 2021-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9920806
关键词：
Address Adoption Adverse event Affect Antidotes Arrhythmia Cessation of life Clinical Colorado Communities Community Health Networks Comorbidity Controlled Study Data Development Drug user Education Electronic Health Record Emergency Medical Technicians Emergency Situation Epidemic Evaluation Event Failure Family member Financial compensation Guidelines HIV Health Health Benefit Health Personnel Health system Home environment Hospitals Integrated Health Care Systems Interview Investigation Knowledge Managed Care Mediating Medical Mental Health Naloxone Neighborhood Health Center Opioid Opioid Antagonist Outcome Overdose Pain Patients Pharmaceutical Preparations Pharmacists Pharmacologic Substance Pharmacy facility Populations at Risk Primary Health Care Process Provider Public Health Qualitative Methods Randomized Research Research Design Research Personnel Risk Risk Behaviors Safety Security Seizures Statistical Methods Statutes and Laws Substance Use Disorder Surveys Techniques United States Ventilatory Depression Work adverse outcome base care providers chronic pain patient emergency settings experience heroin use interest medication safety multidisciplinary novel opioid overdose overdose death overdose risk patient population pragmatic trial prescription opioid prevent primary care setting programs prospective safety assessment safety net

项目摘要

PROJECT SUMMARY Opioid overdoses have reached epidemic proportions in the United States. Our research team, along with other groups, has identified key populations at risk for opioid overdose, including people with HIV, substance use disorders, and mental health conditions. Naloxone is an effective opioid antidote which reverses opioid overdose. Traditionally used by medical personnel, naloxone for take-home use is gaining wider acceptance to prevent death among people who use drugs. Yet, take-home naloxone may also reduce the risk of overdose death among patients prescribed opioids for pain. Our study will examine the safety and impact of expanded access to naloxone for patients prescribed opioids in two large and diverse health systems. These health system pharmacies serve many key risk groups for overdose. While naloxone delivered through health system pharmacies is likely to prevent overdose fatalities, our developmental research has identified critical barriers to wide scale adoption of this practice. These include medical provider concerns that naloxone will increase risk behavior and that patients may not acquire adequate knowledge to effectively use the medication and educate potential bystanders. In addition, providers had concerns about adverse health outcomes associated with naloxone use among patients with co-morbidities. The proposed research will address these key evidence gaps. We will conduct a clustered randomized pragmatic trial of co-dispensing naloxone with opioids under new standing order legislation passed in Colorado. This trial will be conducted in an integrated safety net network of community health centers and hospital and in a large managed care organization. Our outcomes will include opioid risk behavior, overdose and naloxone knowledge, and overdose rates. This will be followed by a qualitative investigation into overdose and naloxone use among people dispensed naloxone to elucidate knowledge gaps, process failures, and unanticipated adverse outcomes. Finally, we will conduct a post- implementation safety assessment of naloxone to examine the risk of adverse health outcomes using novel self-controlled analytic techniques. Together, these aims will provide a comprehensive assessment of the impact and safety of expanded access naloxone for patients prescribed opioids in HIV and other primary care settings.

项目总结