Feasibility of Leveraging the National PulsePoint CPR Responder Network to Facilitate Overdose Education and Naloxone Distribution

项目摘要 在截至2022年9月的12个月里，超过10万名美国人死于服药过量， 其中大部分涉及阿片类药物。投入了大量的国家、州和地方资源 降低美国服药过量死亡的流行率。但不是实质性的下降，而是 自2021年6月以来，每年的服药过量死亡人数一直保持在10万人以上。的确有 没有明显的、单一的解决药物过量流行的方法，这是一个需要多方面合作的“邪恶问题” 针对各种风险因素的预防、治疗和康复系统。然而，它是 明确地说，纳洛酮，一种可以逆转过量服药的阿片类拮抗剂，是一种高效、快速的 可以拯救生命的应对工具。 或许人们不太了解的是，纳洛酮的利用率明显不足；2019年， 在美国，超过四分之一的致命性阿片类药物过量有任何纳洛酮管理的证据 在死前。要使纳洛酮成为有效的解决方案，它必须出现在现场(例如，剂量必须是 在可以使用的过量药物的半径内)，在该半径内的人也需要接受培训 并愿意管理它。外行人服药过量教育与纳洛酮分配(OEND)规划 (例如，旁观者；其他非急救人员或医疗专业人员的公民)已被证明是 在降低致命的过量服药率方面是可行和有效的，但目前还没有足够的覆盖范围。作为一名 解决方案，我们提出了利用PulsePoint Response应用程序和网络来促进OEND的战略 编程。PulsePoint网络是一个现有的全国性网络，首先拥有4400多个社区 与894,744名已表明 愿意在公共场合对昏迷和反应迟钝的人作出回应。这些外行应答者是 当社区第一响应机构将应急小组部署到 在公共场合处于外行人一定半径范围内的昏迷或反应迟钝的人。这意味着 部署个人应对潜在阿片类药物过量的基础设施已经存在并处于活跃状态，但公民 应答者不一定接受过培训(过量教育和纳洛酮使用)或携带纳洛酮。 我们将测试招募PulsePoint机构和非专业响应人员用于OEND的可行性 一项三臂、多阶段随机对照试验，将评估(1)招募社区急救人员 机构和(2)非专业人员参与OEND方案编制，涉及(A)标准招聘条件， (B)过量/纳洛酮错误信息揭穿条件，以及(C)控制条件。我们还将进行 定性跟踪分析。该项目的成功完成将直接通知后续程序- UP R01应用程序通过一项注重结果的随机对照试验来测试此方法 扩大(1,000+)社区样本，目标是有意义地降低社区致命过量服药率。

Project Summary For the 12 months ending in September 2022, more than 100,500 Americans died from an overdose, the majority of which involved opioids. Substantial national, state, and local resources have been invested in reducing the prevalence of overdose deaths in the United States. But rather than substantively declining, the annual overdose death count has remained over 100,000 for year-over-year reports since June 2021. There is no obvious, single solution to the overdose epidemic, which is a ‘wicked problem’ requiring a multifaceted prevention, treatment, and recovery system addressing a wide variety of risk factors. However, it is unequivocally clear that naloxone, an opioid antagonist that can reverse overdose, is a highly effective, rapid response tool that can save lives. What is perhaps less well understood is that naloxone is remarkably underutilized; in 2019, fewer than one quarter of fatal opioid-involved overdoses in the US had any evidence of naloxone administration prior to death. For naloxone to be an effective solution, it must be present at the scene (e.g., a dose must be within a radius of an overdose where it can be used) and someone within that radius also needs to be trained and willing to administer it. Overdose education and naloxone distribution (OEND) programming for laypersons (e.g., bystanders; other citizens who are not first responders or medical professionals) has been shown to be feasible and effective in reducing fatal overdose rates but does not presently have sufficient reach. As a solution, we propose a strategy to leverage the PulsePoint Respond app and network to facilitate OEND programming. The PulsePoint network is an existing, national network of more than 4,400 community first responder agencies who coordinate with 894,744 layperson CPR responders who already have indicated willingness to respond to unconscious and unresponsive persons in public. These layperson responders are notified through the app when a community first response agency deploys an emergency response team to an unconscious or unresponsive person in public who is within a certain radius of the layperson. This means that the infrastructure to deploy individuals to potential opioid overdoses already exists and is active, but the citizen responders have not necessarily been trained (overdose education and naloxone use) or carry naloxone. We will test the feasibility of recruiting PulsePoint agencies and layperson responders for OEND using a 3-arm, multi-stage randomized controlled trial that will assess (1) recruitment of community first responder agencies and (2) layperson engagement with OEND programming across (a) a standard recruitment condition, (b) an overdose/naloxone misinformation debunking condition, and (c) a control condition. We will also conduct qualitative follow-up analyses. Successful completion of this project will directly inform procedures for a follow- up R01 application to test this approach with an outcomes-focused randomized, controlled trial across a much larger (1,000+) community sample with a goal of meaningfully reducing community fatal overdose rates.