Overdose Risk Management and Compensation in the Era of Naloxone

摘要 由于与阿片类药物有关的过量用药的惊人比率已经主导了与毒品有关的全国对话 危害，过量的逆转药物纳洛酮已从急救范围扩大到 将人员转移到公共领域。美国许多州对当前流行性感冒疫情的快速立法反应 阿片类药物依赖和过量导致了广泛的主动提供纳洛酮，而不仅仅是 专业急救人员，但也向活跃的阿片类药物使用者提供服务。这些举措已经证明 它们的价值，并对成千上万的过量用药逆转和拯救生命负责。然而，到目前为止，有两个 与过量教育和纳洛酮分发的持续成功有关的重要议题领域 这些努力仍未得到探索。第一个问题是关于纳洛酮的知识和使用方面的潜在差距。 在使用阿片类药物但没有参与阿片类药物过量预防计划的人中， 大部分外展都是在进行的。第二个问题是很大程度上未被探索的行为和心理社会问题。 纳洛酮过量给药后存活或“逆转”和单纯服用纳洛酮的效果 纳洛酮在从事过量危险行为时存在。初步证据表明，这些 影响可能涉及不同的轨迹，取决于个人和社会结构因素。对一些人来说， 据报道，逆转过量使用能够使个人保持安全的阿片类药物使用做法。为 在其他方面，纳洛酮的规定遇到了自我报告的使用更多阿片类药物的意图。为什么要用纳洛酮 激起如此千差万别的反应，以及它对谁产生了最强劲的健康益处，仍然是 未经过严格审查的问题。为了解决这些公共卫生问题，这项研究回应了 美国国家食品药品监督管理局和美国食品和药物管理局对纳洛酮的额外形成和实施研究 现场环境中的分配和过量干预，特别是对处方阿片类药物滥用者。“使用 混合方法旨在产生丰富的背景研究结果，拟议的研究将招募一名 纽约市600名使用非法阿片类药物的人的样本：a)了解非法阿片类药物的哪些亚组 使用者已经接受了纳洛酮的培训，使用过它，或曾在他们身上使用过它，以及为什么一些人继续拒绝 培训；b)确定使用纳洛酮的风险-行为影响，因以下原因而在过量服药后存活 纳洛酮，或在使用非法阿片类药物时有纳洛酮和一名训练有素的过量应答者在场；以及，c) 说明阿片类药物使用者自己对过量风险管理的看法以及纳洛酮在其中的作用， 并找出积极和消极变化背后的社会结构和心理社会因素 过量的危险行为。总而言之，这些目标有能力告知裁剪和 针对现有的外展和教育战略，并指导制定新的干预措施 阿片类药物使用者的工具，他们接触纳洛酮和过量事件可能代表着强大的转折力- 他们吸毒生涯中的点数和积极行为改变的催化剂。

ABSTRACT As alarming rates of opioid-related overdose have come to dominate the national dialogue on drug-related harms, the overdose reversal medication naloxone has expanded from the confines of emergency medical personnel to the public domain. The rapid legislative response of many US states to the current epidemic of opioid dependence and overdose has resulted in widespread initiatives to provide naloxone not only to professional first-responders, but also to active opioid users. These initiatives have already demonstrated their worth and are responsible for thousands of overdose reversals and lives saved. To date, however, two important topic areas that bear on the ongoing success of overdose education and naloxone distribution efforts remain unexplored. The first concerns potential gaps in knowledge about and access to naloxone among people who use opioids but are not connected to opioid overdose prevention programs where the bulk of outreach is conducted. The second concerns the largely unexplored behavioral and psychosocial effects of surviving or “reversing” an overdose in which naloxone was administered and of simply having naloxone present while engaging in overdose risk behaviors. Preliminary evidence suggests that these impacts may involve different trajectories depending on individual and social-structural factors. For some, reversing an overdose has been reported to empower individuals to maintain safe opioid use practices. For others, naloxone provision has been met with a self-reported intention to use more opioids. Why naloxone provokes such widely varying responses, and for whom it produces the most robust health benefits, remain critically unexamined questions. To address these public health concerns, this study responds to the current NIDA and FDA mandate for “additional formative and implementation studies of naloxone distribution and overdose intervention in field settings, particularly for prescription opioid abusers.” Using a mixed-method approach designed to yield richly contextualized findings, the proposed study will recruit a sample of 600 people who use illicit opioids in New York City to: a) learn which subgroups of illicit opioid users have been trained in naloxone, used it, or had it used on them, and why some continue to refuse training; b) identify the risk-behavior impacts of using naloxone, surviving an overdose because of naloxone, or having naloxone and a trained overdose responder present when using illicit opioids; and, c) illuminate opioid users’ own perspectives on overdose risk management and naloxone’s role within that, and identify social-structural and psychosocial factors underlying both positive and negative changes in overdose risk behavior. Taken together, these objectives have the power to inform the tailoring and targeting of existing outreach and education strategies and to guide the development of new intervention tools for opioid users whose exposure to naloxone and overdose events may represent powerful turning- points in their drug use careers and catalysts for positive behavioral change.