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来测试药物的有效性和成本效益 旨在增加和改善48个注射器服务项目中纳洛酮公平分配的干预措施 （SSP）在整个加州。在过去5年中，阿片类药物过量死亡率增加了114%， 黑人，97%为拉丁裔，32%为白色人群。阿片类药物过量死亡是可以预防的， 纳洛酮，阿片类拮抗剂的及时管理，但我们的研究表明，黑色和拉丁 注射毒品的人（PWID）接受纳洛酮的可能性分别比白色人低25%和47 PWID。在试点工作（R21 DA 046703;主要研究者：Lambdin）的基础上，我们将使用系统 分析和改进方法，以提高公平获得纳洛酮从SSP（SAIA-Naloxone）。在 我们对加州的两个SSP进行的初步研究发现，SAIA-纳洛酮导致平均增加23 接受纳洛酮的人数增加（P<0.001），每周分发的纳洛酮剂量增加64个（P<0.001）。 我们观察到，黑人、土著人或人类参与者的纳洛酮分布增加了116%。 颜色（BIPOC）SAIA-纳洛酮是可行的和可接受的，它导致了有意义的改善， 纳洛酮渗透。我们现在建议在一个大规模的随机对照试验中测试SAIA-纳洛酮。 审判为了有效地解决阿片类药物过量，基于SSP的纳洛酮计划必须让参与者参与 一系列连续的步骤，包括筛选参与者;培训他们纳洛酮给药; 分发纳洛酮;并建立支持参与者拥有纳洛酮的系统， 过量事件，并根据需要获得纳洛酮补充剂。这种模式被称为纳洛酮递送 级联。SAIA-Naloxone是一种多组分实施策略，旨在帮助SSP识别和 解决了纳洛酮传递级联的沿着弱点。它包括级联中压降的确定 交付、流程规划和共识讨论，以确定潜在的解决方案和持续的质量 改进.我们的目的1是测试SAIA-纳洛酮在改善纳洛酮分布方面的有效性， SSP，相对于常规治疗。目的二是检测SAIA-纳洛酮对改善 BIPOC受试者SSP中纳洛酮的分布，相对于常规治疗。目标3是估计 SAIA-纳洛酮改善注射器服务中纳洛酮公平获得的成本和成本效益 相对于常规治疗，该项目将直接有助于改善少数民族 健康和减少健康差距。拟议的研究符合经社部的目标， 卫生与公众服务部和药物滥用和精神卫生服务管理局， 认识到纳洛酮是我们国家预防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.