Preventing Overdose Mortality among People Exiting Incarceration

 描述(由申请人提供)：我们提出了一项R34研究，以开发实用的解决方案，在以出狱人员及其家庭成员为目标的场所实施过量教育和纳洛酮分发(OEND)计划。在过去的十年里，美国的阿片类药物过量死亡率增加了三倍。OEND计划是一种基于证据的生物医学干预措施，包括由有执照的医疗专业人员开出处方和提供纳洛酮，以及有关过量用药风险和如何使用纳洛酮的简要教育。2007年的一项研究发现，前囚犯在出狱后的两周内服药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出狱人员及其家人(他们可能在服药过量时给予纳洛酮)的场所实施OEND。然而，这些场所对OEND的实施构成了独特的挑战，例如需要对方案提供者和材料进行安全审查，目前的重点是戒毒，对吸毒者的知识不足和消极态度，方案编制的空间有限，以及其他复杂性。我们建议：目标1：确定障碍和促进者，并制定解决方案，以便在以出狱人员及其家人为目标的场所(例如，监狱、惩教探视中心、社区监督办公室、重新进入组织)实施OEND方案。目标2：在目标1中确定的两个有希望的场馆试行OEND，目的是评估场馆利益攸关方实施过程的可行性和可接受性。目标3：编写一份手册，阐述在以刑满释放人员及其家属为对象的场所实施《强制戒毒》的关键因素和经验教训，以便在随后的执行试验中使用。拟议的研究将以执行研究综合框架为指导。为了实现目标1，我们将对加利福尼亚州四个不同县的所有惩教和重返社会项目的利益相关者进行半结构化访谈。接下来，我们将向利益攸关方重点小组介绍潜在的实施战略，并征求进一步的意见。在目标2中，我们将向目标1中确定的两个场馆提供技术援助，以试验实施《新规》，目的是评估这些场馆的持份者在实施过程中的可行性和接受性。在目标3中，我们将综合在目标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、多地点的实施试验。对于每一种类型的基于矫正和重新进入的场地，我们将描述实施OEND的障碍、促进者和解决方案。拟议的研究将为推进实施针对高危人群的救生计划提供具体步骤。

 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.