Evaluation of Overdose Prevention Programs for Injection Drug Users

注射吸毒者过量预防方案的评价

• 批准号: 7686401
• 负责人: Stephen E Lankenau
• 金额: $ 19.94万
• 依托单位: CHILDREN'S HOSPITAL OF LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7686401
• 关键词: Acquired Immunodeficiency Syndrome; Address; Affect; Area; Behavior; Blood-Borne Pathogens; Capital; Caring; Case Management; Cessation of life; Characteristics; Communities; Consumption; Data Reporting; Drug Metabolic Detoxication; Drug usage; Enrollment; Environment; Evaluation; Folk Remedy; Frequencies; Fright; Geographic Locations; HIV; HIV Infections; Health behavior; Healthcare; Heroin; Homelessness; Injecting drug user; Injection of therapeutic agent; Interview; Intravenous; Legal; Length; Life; Literature; Location; Los Angeles; Medical; Methods; Naloxone; Names; Narcotic Antagonists; Needle-Exchange Programs; Opioid; Outcome; Overdose; Participant; Patient Self-Report; Pattern; Pharmaceutical Preparations; Police; Population; Prevalence; Prevention; Prevention program; Protocols documentation; Public Health; Qualitative Methods; Recruitment Activity; Reporting; Risk; Risk Behaviors; Role; Route; Sampling Studies; Services; Social Network; Syringes; Techniques; Testing; Training; Training Programs; Translating; Work; base; behavior change; design; heroin overdose; mortality; overdose prevention; programs; psychologic; public health relevance; response; skills; social; social capital

DESCRIPTION (provided by applicant): Drug overdose is the single greatest cause of mortality among injection drug users (IDUs) in the U.S. Fatal heroin overdoses cause more than half of all deaths among IDUs, which far exceeds the proportion of deaths due to AIDS or other causes. Administration of heroin or other opiods via intravenous route not only increases the risk for HIV and other blood-borne pathogens, but also significantly increases the risk a of potentially fatal overdose. Therefore, IDUs are a population at elevated risk for both HIV infection and fatal drug overdose. A heroin overdose can be safely reversed with the administration of naloxone (brand name Narcan) - a legal, nonscheduled opioid antagonist. Naloxone is currently prescribed and distributed by overdose prevention programs (OPP) in 15 states. Despite the common-sense notion that these programs "work," scientifically designed evaluations of OPPs are almost non-existent, and outcomes are still poorly defined. The proposed study is designed to investigate changes in overdose response and other drug-related health behaviors among IDUs participating in two OPPs in Los Angeles. The study will address the following three specific aims: observe changes in overdose response behavior among IDUs; examine whether participating in overdose prevention training or overdose response (i.e. performing a "rescue") affects other drug-related health behaviors; and investigate structural, social, and psychological barriers towards enrolling IDUs into OPPs. The proposed study will use qualitative and quantitative methods to study samples of IDUs recruited from two community-based programs in Los Angeles that conduct overdose prevention training - Homeless Health Care Los Angeles (HHCLA) and Common Ground (CG). Quantitative baseline and "incident report" data will be collected as part of an existing protocol started in November, 2008, to document behaviors in response to witnessed overdoses and circumstances precipitating requests for refills of naloxone. Qualitative in-depth interviews with 150 IDUs (100 trained and 50 untrained) will explore rationales for and barriers to enrolling in overdose prevention training, the effects of training participation, differences between training programs, and the effects of participating in an overdose rescue. PUBLIC HEALTH RELEVANCE: The proposed study will fill a critical gap in the public health literature on opioid overdose and the effects of OPPs among IDUs, who are at elevated risk for death due to overdose. Additionally, the study will provide important information about how the effects of participating in overdose prevention training and practicing prevention skills may be associated with non-overdose related health behaviors, such as HIV risk behavior.

描述(申请人提供)：吸毒过量是美国注射吸毒者死亡的最大原因。致命的海洛因过量导致的死亡占注射吸毒者死亡总数的一半以上，远远超过因艾滋病或其他原因死亡的比例。通过静脉途径给予海洛因或其他阿片类药物不仅增加了艾滋病毒和其他血液传播病原体的风险，而且显著增加了潜在致命过量的风险。因此，注射吸毒者是艾滋病毒感染和致命药物过量的高风险人群。海洛因过量可以通过纳洛酮(商标名纳尔康)-一种合法的、非预定的阿片类药物拮抗剂-安全地逆转。纳洛酮目前由15个州的过量预防计划(OPP)开出和分发。尽管常识认为这些项目“有效”，但对业务方案进行科学设计的评估几乎是不存在的，结果仍然是模糊的。这项拟议的研究旨在调查参与洛杉矶两次OPS的注射吸毒者的过量反应和其他与药物相关的健康行为的变化。这项研究将针对以下三个具体目标：观察注射吸毒者过量反应行为的变化；检查参加过量预防培训或过量反应(即进行“救援”)是否会影响其他与药物有关的健康行为；以及调查吸毒者加入OPPS的结构性、社会和心理障碍。拟议的研究将使用定性和定量的方法来研究从洛杉矶两个进行过量预防培训的社区项目招募的注射吸毒者样本--无家可归者保健洛杉矶(HHCLA)和共同点(CG)。将收集量化基线和“事件报告”数据，作为2008年11月开始的现有议定书的一部分，以记录对目睹的过量服药和促使要求补充纳洛酮的情况作出反应的行为。对150名注射吸毒者(100名受过培训，50名未受过培训)的定性深度访谈将探索参加过量预防培训的理由和障碍，参与培训的效果，培训计划之间的差异，以及参与过量救援的效果。 公共卫生相关性：拟议的研究将填补公共卫生文献中关于阿片类药物过量和注射吸毒者中有机磷农药影响的关键空白，注射吸毒者因过量服药而死亡风险增加。此外，这项研究还将提供重要信息，说明参加过量预防培训和练习预防技能的效果如何与非过量相关的健康行为有关，如艾滋病毒危险行为。