Improving Equitable Access to Naloxone to Prevent Opioid Overdose Deaths Within Syringe Service Programs

我们建议进行一项随机对照试验，以测试一种 旨在增加和改善纳洛酮在48个注射器服务项目中的公平分配的干预措施 (SSP)在整个加利福尼亚州。在过去5年中，阿片类药物过量死亡率上升了114% 黑人，97%在拉丁裔中，32%在白人中。阿片类药物过量死亡是可以预防的 及时给予阿片类拮抗剂纳洛酮，然而我们的研究表明Black和Latinx 注射毒品(PWID)的人接受纳洛酮治疗的可能性分别比怀特低25%和47% PWID。在试点工作(R21DA046703；首席调查员：Lambdin)的基础上，我们将使用这些系统 分析和改进办法，以改善从SSP获得纳洛酮的公平机会(SAIA-Naloxone)。在……里面 我们对加利福尼亚州的两个SSP进行了初步研究，我们发现赛亚-纳洛酮导致了23%的平均增长 每周服用纳洛酮(P&lt；0.001)和的人数更多(P&lt；0.001)。 我们观察到，纳洛酮在黑人、土著或人的参与者中的分布增加了116% 颜色(BIPOC)。赛亚-纳洛酮是可行和可接受的，它导致了有意义的改善 纳洛酮渗透。我们现在建议在大规模随机对照试验中测试赛亚-纳洛酮 审判。为了有效地解决阿片类药物过量问题，基于SSP的纳洛酮计划必须让参与者参与 一系列连续步骤，包括筛选参与者；对他们进行纳洛酮给药培训； 分发纳洛酮；建立支持参与者拥有纳洛酮的系统，在治疗期间使用纳洛酮 过量用药事件，并根据需要补充纳洛酮。这一范例被称为纳洛酮给药 卡斯卡德。SAIA-纳洛酮是一种多组件实施策略，旨在帮助SSP识别和 解决纳洛酮给药过程中的弱点。它包括确定梯级中的落差。 交付、流程规划和共识讨论，以确定潜在的解决方案和持续质量 进步。我们的目标1是测试赛亚-纳洛酮在改善纳洛酮分布方面的有效性 SSP，相对于通常的治疗。目的2是测试赛亚-纳洛酮对改善 纳洛酮在SSP向BIPOC参与者的分配，相对于通常的治疗。目标3是估计 赛亚-纳洛酮改善注射器服务中纳洛酮公平获取的成本和成本-效果 计划，相对于照常治疗。这个项目将直接为少数民族的进步做出贡献 健康和缩小健康差距。拟议的研究与新闻部的目标一致。 卫生和公众服务部以及药物滥用和精神卫生服务局，其中 承认纳洛酮的使用是我国防止阿片类药物过量死亡的第一道防线。

We propose to conduct a randomized controlled trial to test the effectiveness and cost -effectiveness of an intervention designed to increase and improve equitable naloxone distribution in 48 syringe service programs (SSPs) throughout California. In the past 5 years, opioid overdose mortality rates increased 114% among Black, 97% among Latinx, and 32% among White populations. Opioid overdose fatalities are preventable with the timely administration of naloxone, an opioid antagonist, yet our research has shown that Black and Latinx people who inject drugs (PWID) are 25% and 47% less likely, respectively, to receive naloxone than White PWID. Building on pilot work (R21DA046703; Principal Investigator: Lambdin), we will use the Systems Analysis and Improvement Approach to improve equitable access to naloxone from SSPs (SAIA-Naloxone). In our pilot study with two SSPs in California, we found that SAIA-Naloxone led to an average increase of 23 more people receiving naloxone (p<0.001) and 64 more naloxone doses bein g distributed (p<0.001) per week. We observed a 116% increase in naloxone distribution to participants who were Black, Indigenous, or People of Color (BIPOC). SAIA-Naloxone was feasible and acceptable, and it resulted in meaningful improvements in naloxone penetration. We are now proposing to test SAIA-Naloxone in a large-scale randomized controlled trial. To effectively address opioid overdoses, SSP-based naloxone programs must engage participants in a series of sequential steps including screening participants; training them in naloxone administration; distributing naloxone; and building systems that support participants to possess naloxone, use naloxone during overdose events, and obtain naloxone refills as needed. This paradigm is known as the naloxone delivery cascade. SAIA-Naloxone is a multicomponent implementation strategy designed to help SSPs identify and address weaknesses along the naloxone delivery cascade. It includes determination of drop-offs in cascade delivery, process mapping and consensus discussions to identify potential solutions, and continuous quality improvement. Our Aim 1 is to test the effectiveness of SAIA-Naloxone on improving naloxone distribution at SSPs, relative to treatment as usual. Aim 2 is to test the effectiveness of SAIA-Naloxone on improving naloxone distribution at SSPs to BIPOC participants, relative to treatment as usual. Aim 3 is to estimate the cost and cost-effectiveness of SAIA-Naloxone on improving equitable access to naloxone at syringe service programs, relative to treatment as usual. This project will directly contribute to the improvement of minority health and the reduction of health disparities. The proposed study aligns with the goals of the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration, which recognize naloxone access as our nation’s first defense to prevent opioid overdose deaths.