Prisoner Overdose Training and Naloxone Upon Release

描述(申请人提供)：在全国范围内，药物中毒(过量)是成人意外死亡的第二大原因，也是罗德岛和其他15个州成人意外死亡的主要原因。离开监狱或监狱的人因服药过量死亡的风险很高，特别是在获释后的头两周。这项研究试图通过为监狱环境量身定做的预防干预直接解决这一问题。具体目标是：1)制作用于囚犯出狱前使用的预防服药过量和纳洛酮服药培训数字视盘(DVD)；2)评估以阿片类药物过量预防和纳洛酮服药教育DVD为基础的干预措施的可行性和可接受性；以及3)评估参与者在接受干预3个月后对关键阿片类药物服药过量预防/纳洛酮服药行为的保留情况、信心和演示情况。目标人群是罗德岛州惩教署释放后四周内的囚犯，他们自己或认识涉及毒品使用的人。为了实现具体目标，将根据既定的培训方案和为在监狱环境中提供而量身定做的教学培训，开发DVD干预。来自前囚犯、培训师、监狱工作人员和预防服药过量的国家专家的反馈将为DVD的开发提供信息。在为期12个月的实地测试中，125名参与者将参加利用DVD和教学组件的小组形式培训。成功完成培训的参与者在获释后将获得纳洛酮。评估干预措施的保留和可接受性的后续研究将在社区研究地点的监禁释放后3个月进行。这项研究的结果将为未来的随机对照试验研究提供先导数据。成果还将通过在监禁环境中实施，以及通过评估关键的阿片类药物过量预防和纳洛酮管理知识、信心和技能的保留情况来扩大这一领域，这些知识、信心和技能尚未得到正式评估。 公共卫生相关性：由于注射毒品和其他鸦片类药物的使用导致美国服药过量死亡率的大幅上升，以及每年有相当大比例的传统上难以接触到的人口通过惩教设施，因此存在着一个巨大的机会，可以提供关于在监禁环境中预防服药过量的关键教育信息。本申请旨在评估罗德岛州惩教署(RIDOC)对监狱囚犯进行的纳洛酮教育干预。通过这项试点研究产生的数据将有助于开发更大规模的干预试验，这些试验将在出狱后评估纳洛酮干预的有效性。

DESCRIPTION (provided by applicant): Nationally, drug poisonings (overdoses) are the second leading cause of accidental death among adults and the leading cause of adult accidental death in Rhode Island and in 15 other states. Individuals leaving prison or jail are at high risk for death from overdose, especially during the first two weeks after release. This study seeks to directly address this problem through a prevention intervention tailored to the prison setting. Specific aims are to: 1) create an overdose prevention and naloxone administration training Digital Video Disc (DVD) for use with prisoners prior to their release from incarceration; 2) assess the feasibility and acceptability of an opiate overdose prevention and naloxone administration educational DVD based intervention for inmates leaving a correctional facility; and 3)assess participants' retention of knowledge, confidence, and demonstration of critical opiate overdose prevention/naloxone administration behaviors three months after receiving the intervention. The targeted population is inmates who are within four weeks of release from the Rhode Island Department of Corrections who are themselves or know people who are involved in drug use. To accomplish the specific aims, a DVD intervention will be developed based on established training protocols and the didactic training tailored for delivery in a prison setting. Feedback from former prisoners, trainers, prison staff, and national experts in overdose prevention will inform the DVD development. In a field test conducted over a 12-month period, 125 participants will take part in a group format training that utilizes DVD and didactic components. Participants who successfully complete the training will receive naloxone when released from incarceration. Follow-up to assess retention and acceptability of the intervention will occur 3 months post release from incarceration at a community-located study site. Findings from this study will provide pilot data for a future randomized controlled trial study. Results will also expand the field both by its implementation in an incarcerated setting and by evaluating retention of key opiate overdose prevention and naloxone administration knowledge, confidence, and demonstration of skills that have not been formally assessed. PUBLIC HEALTH RELEVANCE: With injection drug use and other opiate use leading to a substantial increase in overdose mortality in the United States, and a substantial proportion of that traditionally hard-to-reach population passing through correctional facilities each year, there exists a tremendous opportunity to provide critical education information regarding overdose prevention in the incarcerated setting. This application aims to evaluate a naloxone education intervention among prison inmates at the Rhode Island Department of Corrections (RIDOC). Data generated through this pilot study will be instrumental for developing larger scale intervention trials which will assess effectiveness of a naloxone intervention upon release from incarceration.