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使用率惊人， 危害，过量逆转药物纳洛酮已从急诊医疗的范围扩大 人员进入公共领域。美国许多州对目前流行的 阿片类药物依赖和过量导致广泛的主动提供纳洛酮，不仅 专业的第一反应者，也包括活跃的阿片类药物使用者。这些举措已经表明， 他们的价值，并负责成千上万的过量逆转和挽救生命。然而，迄今为止， 影响过量教育和纳洛酮分配持续成功的重要主题领域 这些努力尚未得到探索。第一个问题是关于纳洛酮的知识和获得纳洛酮的可能差距 在使用阿片类药物但与阿片类药物过量预防计划无关的人群中， 开展了大量外联活动。第二个是关于基本上未被探索的行为和心理社会 存活或“逆转”纳洛酮给药过量的影响， 纳洛酮存在，同时从事过量的风险行为。初步证据显示， 影响可能涉及不同的轨迹，取决于个人和社会结构因素。对某些人来说， 据报告，逆转过量用药可使个人保持安全的阿片类药物使用做法。为 在其他情况下，纳洛酮的供应与自我报告的使用更多阿片类药物的意图相符。为什么选择纳洛酮 引起如此广泛不同的反应，对谁来说，它产生最强大的健康益处，仍然存在。 未经批判性检验的问题。为了解决这些公共卫生问题，这项研究回应了 目前NIDA和FDA要求进行“纳洛酮的额外形成和实施研究” 分发和过量干预，特别是处方阿片类药物滥用者。使用 混合方法的方法，旨在产生丰富的背景下的结果，拟议的研究将招募一个 在纽约市使用非法阿片类药物的600人的样本，以：a）了解哪些亚组的非法阿片类药物 使用者已经接受过纳洛酮的培训，使用过纳洛酮，或者对他们使用过纳洛酮，以及为什么有些人继续拒绝 培训; B）确定使用纳洛酮的风险行为影响，由于 纳洛酮，或在使用非法阿片类药物时有纳洛酮和经过训练的过量反应者在场;以及c） 阐明阿片类药物使用者自己对过量风险管理的观点和纳洛酮在其中的作用， 并确定积极和消极变化背后的社会结构和心理社会因素， 过量危险行为总的来说，这些目标有能力为定制提供信息， 确定现有外联和教育战略的目标，并指导制定新的干预措施 阿片类药物使用者的工具，他们暴露于纳洛酮和过量事件可能代表着强大的转折- 在他们的吸毒生涯和积极的行为改变的催化剂点。

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.