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

新型执法干预措施对吸毒者健康的影响

• 批准号: 10092137
• 负责人: Peter John Davidson
• 金额: $ 46.09万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10092137
• 关键词: 911 call; Adopted; Affect; Aftercare; Antidotes; Area; Attention; Behavior; Cessation of life; Communities; Complement; County; Crime; Data; Data Analyses; Decision Making; Decision Trees; Drug Controls; Drug user; Emergency Situation; Emergency medical service; Epidemic; Ethnography; Evaluation Research; Event; Fatality rate; Fright; Goals; Health; Human Resources; Individual; Injury; Institutes; Intervention; Interview; Justice; Law Enforcement; Law Enforcement Officers; Lawyers; Life; Medical; Medical emergency; Methods; Modeling; Motor Vehicles; Naloxone; Natural experiment; Nose; Opioid; Opioid Antagonist; Organizational Decision Making; Overdose; Pharmaceutical Preparations; Pharmacotherapy; Phase; Pilot Projects; Police; Policies; Positioning Attribute; Process; Protocols documentation; Public Health; Qualitative Methods; Records; Research; Research Project Grants; Sampling; Savings; Statutes and Laws; Time; Training; United States; Withdrawal Symptom; base; design; empowered; first responder; health goals; improved; innovation; novel; opioid mortality; opioid overdose; overdose death; peer; prescription monitoring program; primary outcome; programs; public health relevance; recruit; response; rural area; secondary analysis; side effect; theories; uptake; willingness

 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).

 描述(申请人提供)：与药物有关的过量死亡现在是美国最大的伤害死亡原因，在2008年超过了与机动车辆有关的死亡。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；加强与药物治疗的联系；培训吸毒者和他们周围的人认识到过量用药并对其作出适当反应；以及最近对执法人员进行培训和装备，使他们能够在过量用药现场使用纳洛酮(一种阿片类拮抗剂)。为执法人员配备纳洛酮是为了利用这样一个事实，即执法人员往往比其他紧急服务机构更早到达吸毒过量现场，特别是在农村地区，而且到目前为止，他们还没有良好的装备来处理吸毒过量事件。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28个州的执法机构正在计划或已经开始携带纳洛酮，供他们服用过量药物时使用。尽管这样的项目激增，但这种干预完全没有研究过。2014年，圣地亚哥警局开始培训巡逻人员在其他急救服务到达之前使用纳洛酮应对过量服药，并在苏醒后积极将过量服药患者转介给合作的药物治疗机构。吸食药物治疗的情况高于预期(该项目6个月试验阶段的9次复苏中有3次进入治疗)。我们假设，过量服药后的片刻代表着吸毒者可能更有动力进入治疗的“可教的时刻”。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来应对，可能会使吸毒者在有人吸毒过量时更愿意拨打911。这项研究的总体目标是确定执法部门使用纳洛酮应对吸毒过量对两个主要结果的影响：(1)执法人员转介的吸毒过量受害者接受药物治疗转介；(2)目睹吸毒过量的吸毒者拨打911呼叫紧急医疗服务的比率。我们将通过一项混合方法研究来实现这些目标，其中包括对通过我们与SDSD、他们的药物治疗合作伙伴McAlister Institute和圣地亚哥县合作获得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进行定性访谈，以评估他们对SDSD副手提供的治疗转介的看法，以及他们在目睹服药过量时拨打911的意愿。访谈和分析将利用扎根理论和人种学决策树模型(一种用于描述个人和组织在特定情况下如何做出决策的严格定性方法)中的方法。

项目成果

Patient brokering in for-profit substance use disorder treatment: a qualitative study with people with opioid use disorder and professionals in the field.

• DOI: 10.1186/s12913-023-10217-z
• 发表时间: 2023-11-06
• 期刊: BMC HEALTH SERVICES RESEARCH
• 影响因子: 2.8
• 作者: Clingan, Sarah E.;D'Ambrosio, Brittany M.;Davidson, Peter J.
• 通讯作者: Davidson, Peter J.

"I wanted to close the chapter completely … and I feel like that [carrying naloxone] would keep it open a little bit": Refusal to carry naloxone among newly-abstinent opioid users and 12-step identity.

• DOI: 10.1016/j.drugpo.2021.103200
• 发表时间: 2021-08
• 期刊: INTERNATIONAL JOURNAL OF DRUG POLICY
• 影响因子: 4.4
• 作者: Bowles, J. M.;Smith, L. R.;Mittal, M. L.;Harding, R. W.;Copulsky, E.;Hennessy, G.;Dunkle, A.;Davidson, P. J.;Wagner, K. D.
• 通讯作者: Wagner, K. D.