Evaluating naloxone-on-release from incarceration as community overdose prevention

项目摘要 本研究的首要目标是评价高容量、低阈值的纳洛酮释放方案 正在为从洛杉矶县监狱系统释放的个人服务。 阿片类药物过量死亡是美国意外死亡的最大单一原因。 从监禁中释放出来的个人面临的风险特别大，一些研究表明，他们面临的风险是： 释放后数周内的死亡率是一般人的129倍。 一种被证明可以减少阿片类药物相关死亡的干预措施是培训阿片类药物使用者及其家属。 立即社交圈认识到过量，并通过使用纳洛酮作出反应，纳洛酮是一种阿片类拮抗剂， 有效地“逆转”过量。过量教育和纳洛酮分配（OEND）计划现在 几乎每个州都有。然而，获得OEND方案的机会并不公平， 使用阿片类药物的美国人和拉丁裔人不太可能获得OEND，这是一个特别值得关注的问题， 阿片类药物相关的过量死亡率在黑人中增加了114%，在拉丁裔人口中增加了97%， 在过去的五年里，白人的比例为32%。最近的一项创新，“纳洛酮释放”，旨在 解决从监禁中释放出来的人吸毒过量的比例特别高的问题。在 此外，纳洛酮控释片有可能覆盖传统OEND服务不足的人群 考虑到非裔美国人和拉丁裔人在被监禁人口中的比例过高， 全国范围目前美国至少有28个试点或早期纳洛酮释放项目，但 迄今为止，关于这些方案的文献主要限于对可行性和后勤问题的描述。一 一篇论文描述了苏格兰一个国家级项目的效果，令人惊讶的是， 在释放后的四周内，释放人员中过量死亡的比例下降。 2020年1月，洛杉矶治安部门实施了纳洛酮释放计划， 所有从洛杉矶县监狱系统释放的囚犯都要接受关于过量服用的视频培训 识别和反应，并能够采取尽可能多的剂量纳洛酮，因为他们希望从一个免费的自动售货机 机器在释放点。2020年该计划分发了31，352剂纳洛酮，几乎 是洛杉矶所有其他OEND项目总和的两倍，是迄今为止规模最大的 该计划在世界范围内（上述苏格兰计划在3年内分发了2，273剂）。 我们将使用创新的混合方法设计来利用这个及时的机会，并检查 纳洛酮释放计划是否为那些风险最大的人服务，该计划是否达到 以前服务不足的人群，该计划如何影响释放者返回的社区，以及 该计划是否减少了被释放者及其返回社区的死亡人数。

Project Summary The overarching goal of this study is to evaluate a high-volume, low-threshold, naloxone-on-release program serving individuals being released from the Los Angeles County Jail system. Opioid-related overdose death is the single largest cause of accidental death in the United States. Individuals being released from incarceration are at particular risk, with some studies showing their risk of death in the weeks immediately after release is as much as 129 times that of the general population. One intervention demonstrated to reduce opioid-related deaths is training opioid users and those in their immediate social circles to recognize overdose and to respond by using naloxone, an opioid antagonist which effectively ‘reverses’ overdose. Overdose Education and Naloxone Distribution (OEND) programs are now present in almost every state. However, access to OEND programs has not been equitable, with African American and Latinx people who use opioids being less likely to access OEND, a particular concern given opioid-related overdose mortality has increased 114% among Black and 97% among Latinx populations over the last 5 years compared to 32% among Whites. One recent innovation, ‘naloxone-on-release’, aims to address the particularly high rate of overdoses experienced by individuals being released from incarceration. In addition, naloxone-on-release has the potential to reach populations underserved by traditional OEND programs given the over-representation of African American and Latinx people in incarcerated populations nationwide. At least 28 pilot or early stage naloxone-on-release programs currently exist in the US, however to date the literature on these programs is largely limited to descriptions of feasibility and logistical issues. A single paper describes the efficacy of a national-level program in Scotland, which, encouragingly, saw a 36% drop in the proportion of overdose deaths among releasees in the four weeks following release. In January 2020 the Los Angeles Sheriff’s Department implemented a naloxone-on-release program, in which all inmates being released from the LA County Jail system are exposed to a video training on overdose recognition and response and are able to take as many doses of naloxone as they wish from a no-cost vending machine at the point of release. 31,352 doses of naloxone were distributed by the program in 2020, almost twice as much as every other OEND program in Los Angeles combined, and making it by far the largest such program in the world (the Scottish program described above distributed 2,273 doses over 3 years). We will use an innovative mixed-methods design to capitalize on this timely opportunity, and examine whether the naloxone-on-release program is serving those most at risk, whether the program reaches previously underserved populations, how the program impacts the communities to which releasees return, and whether the program reduces deaths among releasees and in the communities to which they return.