Increasing Naloxone Access for Persons who use Opioids: An Online Recruitment and Training Approach to Opioid Overdose Education and Naloxone Distribution

药物过量是美国意外死亡的主要原因，超过65%的药物 使用类阿片造成的相关死亡。阿片类药物过量死亡率的不断增加， 过去二十年导致宣布类阿片流行病。从1999年开始的短短15年里， 2014年，与药物过量相关的死亡人数增加了两倍，自那时以来，死亡率继续急剧上升。联邦 各机构对这场危机作出了回应，提出了各种建议，包括加强减少危害 例如纳洛酮分布。纳洛酮是一种阿片拮抗剂，可用于逆转阿片类药物 服药过量虽然它通常是在急诊室管理，外行最近被 通过阿片类药物过量教育和纳洛酮分配（OEND）计划成功培训， 识别阿片类药物过量的迹象，并在家庭和社区及时给予纳洛酮 在等待医疗服务的过程中。一些研究表明，OEND程序有效地 降低阿片类药物过量死亡率，安全且具有成本效益。但是，OEND程序通常 在城市地区实施，作为大型医疗中心研究计划的一部分，针具交换，或药物 治疗方案。生活在没有这些方案或服务的地区的个人无法获得关键和 救命的OEND目前的建议将审查网上征聘的可接受性和可行性， 在线阿片类药物过量教育和纳洛酮药盒的邮寄分发（N=80）。阿片类药物使用者面临以下风险 将通过克雷格列表网招募如果合格，参与者将完成阿片类药物使用 调查问卷，并将表明他们是否有兴趣接受阿片类药物过量和纳洛酮给药 训练如果有兴趣，他们将完成干预前和干预后的知识问卷， 视听培训，一半将被随机接受纳洛酮套件的邮件，而另一半将 提供他们可以获得纳洛酮药盒的信息。所有参与者将完成远程随访 在研究后1、2和3个月进行评估，以评价纳洛酮药盒的使用和结局。本研究将 评估一种新的方法，为那些无法获得此类信息的个人提供OEND。 干预通过该项目成功实施远程OEND将支持未来的 采用类似的远程程序，将这一关键的减少伤害策略扩展到高风险个体 在缺乏传统OEND项目的地区。

Drug overdose is the leading cause of accidental death in the United States, with over 65% of drug related fatalities resulting from the use of opioids. The continually increasing rates of opioid overdose deaths in the last two decades have led to the declaration of an opioid epidemic. Over a brief 15-year period, from 1999- 2014, drug overdose related deaths tripled and rates have continued to sharply escalate since then. Federal agencies have responded to this crisis with various recommendations including enhancing harm reduction approaches such as naloxone distribution. Naloxone is an opioid antagonist that can be used to reverse opioid overdose. Though it is typically administered in Emergency Departments, laypersons have recently been successfully trained through Opioid Overdose Education and Naloxone Distribution (OEND) programs to recognize signs of opioid overdose and perform timely administration of naloxone in homes and community settings while awaiting medical services. Several studies have demonstrated that OEND programs effectively reduce opioid overdose mortality and are safe and cost-effective. However, OEND programs are typically implemented in urban areas as part of large medical center research programs, needle exchanges, or drug treatment programs. Individuals living in areas without these programs or services lack access to critical and life-saving OEND. The current proposal will examine the acceptability and feasibility of online recruitment, online opioid overdose education, and postal distribution of naloxone kits (N=80). Opioid users at risk for overdose will be recruited online through Craigslist. If eligible, participants will complete an opioid use questionnaire and will indicate if they are interested in receiving opioid overdose and naloxone administration training. If interested, they will complete pre- and post-intervention knowledge questionnaires, engage in audiovisual training, and half will be randomized to receive a naloxone kit in the mail while the other half will be given information on where they can receive a naloxone kit. All participants will complete remote follow-up assessments at 1, 2, and 3 months post study to evaluate naloxone kit use and outcomes. This study will evaluate a novel approach to providing OEND to individuals with otherwise limited access to this type of intervention. Successful implementation of remote OEND through this project would support future employment of similar remote programs to expand this critical harm reduction strategy to high-risk individuals in areas lacking traditional OEND programs.