A social diffusion fatal overdose prevention intervention: Assessing the effectiveness of people who use opioids as peer educators in training using & non-using networks on overdose & stigma reduction

项目摘要 致命性过量是阿片类药物使用者死亡的主要原因。然而，致命的过量服药可能 如果及时给予纳洛酮，则可以预防。吸毒过量的旁观者处于有利的地位 管理纳洛酮，可以包括使用和不使用药物的人。在我们之前的工作中，我们有 表明PWUO可以成为预防过量用药的同伴教育者(PES)。在之前的干预中，我们有 重点是培训使用药物的网络成员对过量服药的反应。然而，试点数据表明， 不吸毒的人也经常目睹吸毒过量。吸毒者的耻辱可能会影响PWUO 与未使用的网络以及未使用的网络进行关于预防服药过量的对话 会员愿意一直携带纳洛酮。根据试点数据，我们建议扩大服药过量的同龄人 教育干预，重点是不使用网络成员和解决吸毒者污名问题。这个 干预旨在使网络成员做好应对服药过量的准备，并使有关 PWUO与其网络成员之间的药物过量预防规划。使用随机对照试验研究设计，300 INDEX PWUO将与450名网络成员一起招募。索引将被随机分配给 (1)护理标准(SOC)或(2)实验性同伴教育条件(PEC)。建议的设计允许 对未使用网络成员进行培训和提高干预效果的审查 PWUO及其网络成员之间的通信。我们将使用移动健康来评估地理位置 同伴教育和地理位置污名的覆盖范围，以了解与 PES的地理空间覆盖。RE-AIM框架将指导收集定性访谈数据，以 确定干预措施实施的障碍和促进者。参赛者将每6个月接受一次评估 2年。拟议的设计还将允许纵向检查社会和社会之间的路径 心理、心理健康因素和过量用药行为，可以指导未来的干预。 目标1：实施和评估同等关注的两组RCT PWUO同伴教育者干预 重点培训网络成员，特别是非吸毒网络成员，鼓励吸毒过量 预防和应对行为。 目标2：评估与同行外联和地理空间/社会地理空间复盖有关的因素 使用EMA/mHealth定位吸毒者污名。

Project Summary Fatal overdose is a major cause of mortality among people who use opioids (PWUO). Yet, fatal overdose can be prevented when naloxone is promptly administered. Bystanders of an overdose are well positioned to administer naloxone and can include both people who use and do not use drugs. In our prior work, we have shown that PWUO can be peer educators (PEs) for overdose prevention. In previous interventions we have focused on training network members who use drugs to respond to an overdose. Yet, pilot data suggests that overdoses are also often witnessed by people who do not use drugs. Drug user stigma may impact PWUO engaging in conversations about overdose prevention with non-using networks as well as non-using network members’ willingness to always carry naloxone. Based on pilot data, we propose expanding an overdose peer education intervention to focus on non-using network members and to address drug user stigma. The intervention seeks to prepare network members to respond to an overdose and normalize discussion about overdose prevention planning between PWUO and their network members. Using an RCT study design, 300 index PWUO will be recruited along with 450 network members. The indexes will be randomly assigned to the (1) standard of care (SOC) or (2) an experimental peer education condition (PEC). The proposed design allows examination of the effectiveness of the intervention to train non-using network members and enhance communications among PWUO and their network members. We will use mHealth to assess geographic coverage of peer education and geospatially situated stigma in order to understand factors associated with the geospatial coverage of the PEs. The RE-AIM framework will guide the collection of qualitative interview data to identify barriers and facilitators to intervention implementation. Participants will be assessed every 6 months for 2 years. The proposed design also will allow for the longitudinal examination of pathways between social and psychological, and mental health factors and overdose behaviors which can guide future interventions. Aim 1: Implement and evaluate an equal attention 2-group RCT PWUO peer educator intervention that focuses on training network members, especially non-drug using network members, to encourage overdose prevention and response behaviors. Aim 2: Assess factors associated with geospatial coverage of peer outreach and geospatially/socially situated drug user stigma using EMA/mHealth.