Church-Tailored Opioid Overdose Education and Naloxone Distribution to Target Overdose and Stigma Among African-American Communities

非洲裔美国人（AAs）死于阿片类药物过量的速度比世界上任何种族/族裔群体都快。 美国的此外，可卡因中掺入芬太尼的增加可能进一步加剧风险， 阿片类药物过量在过去的10年里，基于同伴的过量教育和纳洛酮 分发（OEND）已成为广泛使用的阿片类药物过量危害减少实践。OEND程序 寻求增加对服药过量风险因素、症状和有效急救的了解（例如，救援 呼吸），消除无效治疗的神话（例如，盐镜头），并增加获得过量- 逆转剂纳洛酮。OEND计划主要针对通过以下方式使用阿片类药物的高风险人群 治疗或注射器交换计划，因此，需要扩大获得OEND的途径。AA是 更有可能从教堂而不是正规的药物治疗中心寻求药物使用的帮助。教会背景 干预措施在文化上是可以接受的，减少了获得的障碍，并可以在资源不足的地区扩大规模。 社区.要使OEND在黑人教堂中有效，可能需要剪裁。对于这些观众来说， 标准的OEND课程可能需要适应他们对物质使用障碍的知识水平 （SUD），有限的一般心理健康知识，并特别解决与SUD有关的耻辱， 阿片类药物使用障碍（MOUD）。最后，可能需要制定一项有针对性的实施战略， 上下文变化（例如，（1）教会的规模和规模。在之前的一次审判中， 研究小组开发了一个全面的过量教育和技能培训（COEST），针对 阿片类药物使用者COEST显著增加了对过量风险因素的了解， 关于干预过量事件的态度。在一项随机对照试验中，COEST（与基础OEND相比 培训）增加了纳洛酮的使用（在阿片类药物过量的疑似病例中）近20%。拟议 试点研究的目的是确定社会文化的修改，将需要适应COEST的目标黑人 信仰的社区。研究的第一阶段将涉及与神职人员， OUD和兴奋剂使用障碍，教会成员和以前被监禁的成年人。定性信息 结果，研究小组的社区咨询委员会将使用“干预映射”来调整AA的COEST 教堂第2阶段将涉及一项适应性COEST的试点随机对照试验（RTC）， 教会内最需要OEND服务的目标群体：（1）患有 OUD;（2）囚犯重返社会;（3）吸毒支助/卫生部。RTC将使用 阶梯楔形设计，以评估COEST是否增加纳洛酮的利用，减少SUD的耻辱， 对MOUD的负面看法，并提高心理健康素养。这项试点试验旨在为一个 大规模R 01进行混合型2适应性实施试验的适应性干预。

African Americans (AAs) are dying from opioid overdoses faster than any racial/ethnic group in the United States. Furthermore, the increased adulteration of cocaine with fentanyl may further exacerbate the risk of opioid overdose among AAs. Over the past 10 years, peer-based overdose education and naloxone distribution (OEND) has become a widely used opioid overdose harm reduction practice. OEND programs seek to increase knowledge of overdose risk factors, symptoms, and efficacious first aid (e.g., rescue breathing), dispel myths of ineffective treatments (e.g., salt shots), and increase access to the overdose- reversal agent, naloxone. OEND programs largely target high-risk individuals who use opioids through treatment or syringe exchange programs, and thus, ways to expand access to OEND are needed. AAs are more likely to seek help for drug use from churches than formal drug treatment centers. Church-based interventions are culturally acceptable, reduce access barriers, and can be brought to scale in under-resourced communities. For OEND to be efficacious in Black churches, tailoring may be needed. For this audience, standard OEND curricula may need to be adapted to their level of knowledge of substance use disorders (SUDs), limited general mental health literacy, and to specifically address stigma related to SUDs and medications for opioid use disorder (MOUD). Finally, a tailored implementation strategy may need to address contextual variations (e.g., denomination and membership size) across churches. In a previous trial, the research team developed a Comprehensive Overdose Education and Skills Training (COEST), targeting experienced opioid users. COEST significantly increased knowledge of overdose risk factors and improved attitudes about intervening in an overdose event. In a randomized controlled trial, COEST (vs basic OEND training) increased naloxone utilization (in suspected cases of opioid overdose) by nearly 20%. The proposed pilot study aims to identify the socio-cultural modifications that will be needed to adapt COEST to target Black communities of faith. Phase 1 of the study will involve key stakeholder interviews with clergy, individuals with OUD and stimulant use disorder, church members, and formerly incarcerated adults. Informed by qualitative results, the study team’s Community Advisory Board will use “intervention mapping” to adapt COEST for AA churches. Phase 2 will involve a pilot randomized controlled trial (RTC) of adapted COEST among three target groups within the church who are most in need of OEND services: (1) Family and Friends of People with OUD; (2) Prisoners Re-Entering Society; and (3) Drug Use Support / Health Ministry. The RTC will use a stepped-wedge design to assess whether COEST increases naloxone utilization, reduces SUD stigma and negative perceptions of MOUD, and increases mental health literacy. This pilot trial aims to generate data for a large-scale R01 to conduct a Hybrid Type-2 Effectiveness-Implementation trial of the adapted intervention.