Impacts of a Novel law-enforcement delivered intervention on drug user health

 描述（由申请人提供）：药物相关的过量死亡现在是美国伤害死亡的最大原因，在2008年超过了机动车相关的死亡。在过去十年中，针对这一流行病出现了一些干预措施，包括处方药监测方案;改善与药物治疗的联系;培训吸毒者及其周围的人认识并适当应对过量;以及最近培训和装备执法人员在过量现场使用纳洛酮（阿片类拮抗剂）。为执法人员配备纳洛酮是为了利用这样一个事实，即官员经常在其他紧急服务之前到达过量现场，特别是在农村地区，而且到目前为止还没有很好的装备来处理过量事件。在过去的5年里，在白宫国家药物管制政策办公室和司法部的积极鼓励下，至少有28个州的执法机构正在计划或已经开始携带纳洛酮，以便在过量服用时使用。尽管这类项目激增，但这种干预完全未经研究。2014年，圣地亚哥治安部门开始培训巡逻人员在其他紧急服务到达之前使用纳洛酮应对过量，并在复兴后积极将过量受害者转介给合作药物治疗机构。药物治疗的接受率高于预期（该项目6个月试点阶段9例复苏中有3例进入治疗）。我们假设，过量用药后的时刻代表了一个“可教的时刻”，吸毒者可能更有动力进入治疗。此外，我们假设，让执法人员将吸毒过量作为医疗紧急情况而不是犯罪现场，可能会使吸毒者在有人吸毒过量时更愿意拨打911。本研究的总体目标是确定执法部门使用纳洛酮应对药物过量对两个主要结局的影响：（1）执法人员转介的药物过量受害者接受药物治疗转介，以及（2）目睹药物过量的吸毒者拨打911召唤紧急医疗服务的比率。我们将通过一项混合方法研究实现这些目标，该研究包括对我们与SDSD、其药物治疗合作伙伴麦卡利斯特研究所和圣地亚哥县的合作提供的数据进行二次分析，包括911调度数据、SDSD病例记录和治疗数据。为了补充这些数据，我们将对社区招募的吸毒者样本进行定性访谈，以评估他们对SDSD代表提供的治疗转介的看法，以及他们在目睹过量用药时拨打911的意愿。访谈和分析将利用扎根理论和人种学决策树建模（一种用于描述个人和组织如何在特定情况下做出决策的严格定性方法）的方法。

 DESCRIPTION (provided by applicant): Drug-related overdose deaths are now the largest cause of injury death in the United States, having eclipsed motor vehicle-related deaths in 2008. A number of interventions have emerged in the last decade in response to this epidemic, including prescription drug monitoring programs; improving linkages to drug treatment; training drug users and those around them to recognize and respond appropriately to overdose; and, most recently, training and equipping law enforcement officers to use naloxone (an opioid antagonist) at the scene of an overdose. Equipping law enforcement officers with naloxone is intended to capitalize on the fact that officers often arrive at an overdose scene before other emergency services, particularly in rural areas, and until now have not been well equipped to deal with overdose events. In the last 5 years, with the active encouragement of the White House Office of National Drug Control Policy and the Department of Justice, law enforcement agencies in at least 28 states are planning to or have begun carrying naloxone to use when they attend overdoses. Despite the proliferation of such programs, this intervention is completely unstudied. In 2014 the San Diego Sheriff's Department began training patrol officers to use naloxone to respond to overdose prior to arrival of other emergency services, and to actively refer overdose victims to a collaborating drug treatment agency after revival. Uptake of drug treatment has been higher than expected (3 of 9 revivals in the 6 month pilot phase of the project entered treatment). We hypothesize that the moments after an overdose represent a "teachable moment" in which drug users may be more motivated to enter treatment. In addition, we hypothesize that having law enforcement officers respond to overdose as a medical emergency rather than as a crime scene may make drug users more willing to call 911 when someone overdoses. The overarching goal of this study is to determine the impact of law enforcement use of naloxone to respond to drug overdoses on two primary outcomes: (1) uptake of drug treatment referrals by overdose victims referred by law enforcement officers, and (2) rates of calling 911 to summon emergency medical services by drug users who witness overdoses. We will achieve these aims through a mixed methods study that includes secondary analysis of data available through our partnership with SDSD, their drug treatment partners the McAlister Institute, and the County of San Diego, including 911 dispatch data, SDSD case records, and treatment data. To complement these data we will conduct qualitative interviews with a community-recruited sample of drug users, to assess their perspectives around treatment referrals provided by SDSD Deputies, and their willingness to call 911 in the event of witnessed overdoses. Interviews and analysis will utilize methods drawn from grounded theory and ethnographic decision tree modeling (a rigorous qualitative method used to describe how individuals and organizations make decisions in given situations).