Preventing Overdose Mortality among People Exiting Incarceration

防止出狱人员因服药过量死亡

• 批准号: 9032487
• 负责人: ALEXANDER H KRAL
• 金额: $ 23.89万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9032487
• 关键词: Abstinence; Address; Administrator; Attitude; California; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinic; Communities; County; Coupled; Drug usage; Drug user; Education; Effectiveness; Emergency Situation; Event; Evidence based program; Family member; Focus Groups; General Population; Goals; Health; Healthcare Systems; High Prevalence; Imprisonment; Injury; Institution; Intervention; Interview; Jail; Journals; Knowledge; Learning; Licensing; Life; Manuals; Medical; Medicine; Methadone; Modeling; Motor Vehicles; Naloxone; Narcotic Antagonists; National Institute of Drug Abuse; New England; Opioid; Overdose; Pain Clinics; Paramedical Personnel; Persons; Pharmacy facility; Population; Preparation; Prisons; Procedures; Process; Provider; Research; Risk; Security; Services; Site; Structure; Supervision; Testing; Time; Training; United States; United States Substance Abuse and Mental Health Services Administration; Visit; Work; base; community center; cost effectiveness; effectiveness trial; experience; high risk; implementation research; implementation trial; interest; mortality; multi-site trial; novel; opiate tolerance; overdose death; parole; point of care; prevent; probation; programs; response; treatment program

 DESCRIPTION (provided by applicant): We propose an R34 study to develop pragmatic solutions for implementing overdose education and naloxone distribution (OEND) programs in venues that target people exiting incarceration and their family members. Opioid overdose mortality has increased threefold in the last decade in the United States. OEND programs are an evidence-based biomedical intervention that involves the prescription and provision of naloxone by a licensed medical professional along with brief education about overdose risks and how to use naloxone. A 2007 study found that former inmates had 129 times the risk of overdose death during the 2 weeks immediately following release from prison than the general population. Therefore, there is a dire need for implementation of OEND in venues that specifically target people exiting incarceration and their family members (who may be able to administer naloxone in the event of an overdose). However, these venues pose unique challenges to OEND implementation, such as the need for security clearances for program providers and materials, the current focus on abstinence from drug use, inadequate knowledge of and negative attitudes toward drug users, limited space for programming, and other complexities. We propose: Aim 1: To identify barriers and facilitators to and develop solutions for the implementation of OEND programs in venues that target people exiting incarceration and their family members (e.g., jails, correctional visiting centers, community supervision offices, reentry organizations). Aim 2: To pilot the implementation of OEND in two promising venues identified in Aim 1 with the goal of assessing feasibility and acceptability of the implementation process among venue stakeholders. Aim 3: To develop a manual addressing the key factors and lessons learned about the implementation of OEND in venues that target people exiting incarceration and their family members for use in a subsequent implementation trial. The proposed study will be guided by the Consolidated Framework for Implementation Research. To achieve Aim 1, we will conduct semi- structured interviews with stakeholders in all correctional and re-entry programs in four diverse counties in California. Next, we will present potential implementation strategies to stakeholder focus groups and solicit further input. In Aim 2, we will provide technical assistance to two venues identified in Aim 1 to pilot the implementation of OEND, with the goal of assessing the feasibility and acceptability of the implementation process by stakeholders in these venues. In Aim 3, we will synthesize the knowledge acquired in Aims 1 and 2 to develop an implementation manual to be used in a subsequent R01 study to conduct a large-scale, multi-site implementation trial. For each type of correctional and re-entry based venue, we will delineate the barriers, facilitators, and solutions developed to implementing OEND. The proposed research will provide concrete steps for advancing the implementation of a life-saving program for a high-risk population.

 描述（由申请人提供）：我们提出了一项R34研究，以制定务实的解决方案，在针对退出监禁的人及其家人的场所实施过量教育和纳洛酮分配（OEND）计划。过去十年，美国阿片类药物过量死亡率增加了三倍。OEND计划是一种循证生物医学干预措施，涉及由持牌医疗专业人员沿着关于过量风险和如何使用纳洛酮的处方和提供。2007年的一项研究发现，出狱后两周内吸毒过量死亡的风险是普通人群的129倍。因此，迫切需要在专门针对退出监禁的人及其家庭成员（在过量的情况下，他们可能能够管理纳洛酮）的场所实施OEND。然而，这些场所对OEND的实施提出了独特的挑战，例如需要对方案提供者和材料进行安全审查，目前对戒毒的关注，对吸毒者的认识不足和消极态度，规划空间有限以及其他复杂性。我们建议：目标1：确定障碍和促进因素，并制定解决方案，以在针对出狱者及其家人的场所实施OEND计划（例如，监狱、教养访问中心、社区监督办公室、重返社会组织）。目标二：在目标1中确定的两个有希望的场馆试行开放式环境结束，目的是评估场馆利益相关者实施过程的可行性和可接受性。目标三：编写一份手册，说明在以刑满释放人员及其家庭成员为目标的场所实施开放式结束方案的关键因素和经验教训，供随后的实施试验使用。拟议的研究将以执行情况研究综合框架为指导。为了实现目标1，我们将与加州四个不同县的所有矫正和重返社会计划的利益相关者进行半结构化访谈。接下来，我们将向利益相关者焦点小组介绍可能的实施战略，并征求进一步的意见。在目的2方面，我们会为目的1所指的两个场地提供技术支援，以试验推行开放式终端服务，目的是评估这些场地的持份者对推行过程的可行性和接受程度。在目标3中，我们将综合目标1和目标2中获得的知识，以制定一份实施手册，用于随后的R01研究，以进行大规模、多中心的实施试验。对于每一种类型的矫正和重返社会的场所，我们将描绘的障碍，促进者，并制定实施开放式结束的解决方案。拟议的研究将为推动实施高危人群的救生计划提供具体步骤。