Evaluation of Overdose Prevention Programs for Injection Drug Users

描述（申请人提供）：药物过量是美国注射毒品使用者（IDUs）死亡的唯一最大原因。致命的海洛因过量导致超过半数的IDUs死亡，远远超过艾滋病或其他原因导致的死亡比例。通过静脉途径给予海洛因或其他阿片类药物不仅增加了感染艾滋病毒和其他血液传播病原体的风险，而且还显著增加了潜在致命过量的风险。因此，注射吸毒者是感染艾滋病毒和致命药物过量的高风险人群。海洛因过量可以安全地逆转与管理纳洛酮（品牌名称纳康）-一个法律的，非预定阿片类拮抗剂。纳洛酮目前由15个州的过量预防计划（ODA）处方和分发。尽管常识性的观念认为这些计划“有效”，但科学设计的OPP评估几乎不存在，结果仍然很难定义。拟议的研究旨在调查在洛杉矶参加两个OPP的注射吸毒者中过量反应和其他药物相关健康行为的变化。该研究将涉及以下三个具体目标：观察注射吸毒者过量反应行为的变化;检查参加过量预防培训或过量反应（即进行“抢救”）是否影响其他与药物有关的健康行为;调查将注射吸毒者纳入OPP的结构、社会和心理障碍。拟议的研究将使用定性和定量方法研究从洛杉矶两个社区计划招募的注射吸毒者样本，这些计划进行过量预防培训-无家可归者保健洛杉矶（HHCLA）和共同点（CG）。将收集定量基线和“事件报告”数据，作为2008年11月开始的现有方案的一部分，以记录对目睹的过量用药和促使要求重新填充纳洛酮的情况的反应。对150名注射吸毒者（100名受过培训，50名未经培训）进行定性深入访谈，探讨参加过量预防培训的理由和障碍、培训参与的影响、培训方案之间的差异以及参与过量救援的影响。 公共卫生相关性：这项拟议的研究将填补公共卫生文献中关于阿片类药物过量和OPPs在注射吸毒者中的影响的关键空白，这些人因过量而死亡的风险较高。此外，该研究将提供有关参与过量预防培训和实践预防技能的影响如何与非过量相关健康行为（如HIV风险行为）相关的重要信息。

DESCRIPTION (provided by applicant): Drug overdose is the single greatest cause of mortality among injection drug users (IDUs) in the U.S. Fatal heroin overdoses cause more than half of all deaths among IDUs, which far exceeds the proportion of deaths due to AIDS or other causes. Administration of heroin or other opiods via intravenous route not only increases the risk for HIV and other blood-borne pathogens, but also significantly increases the risk a of potentially fatal overdose. Therefore, IDUs are a population at elevated risk for both HIV infection and fatal drug overdose. A heroin overdose can be safely reversed with the administration of naloxone (brand name Narcan) - a legal, nonscheduled opioid antagonist. Naloxone is currently prescribed and distributed by overdose prevention programs (OPP) in 15 states. Despite the common-sense notion that these programs "work," scientifically designed evaluations of OPPs are almost non-existent, and outcomes are still poorly defined. The proposed study is designed to investigate changes in overdose response and other drug-related health behaviors among IDUs participating in two OPPs in Los Angeles. The study will address the following three specific aims: observe changes in overdose response behavior among IDUs; examine whether participating in overdose prevention training or overdose response (i.e. performing a "rescue") affects other drug-related health behaviors; and investigate structural, social, and psychological barriers towards enrolling IDUs into OPPs. The proposed study will use qualitative and quantitative methods to study samples of IDUs recruited from two community-based programs in Los Angeles that conduct overdose prevention training - Homeless Health Care Los Angeles (HHCLA) and Common Ground (CG). Quantitative baseline and "incident report" data will be collected as part of an existing protocol started in November, 2008, to document behaviors in response to witnessed overdoses and circumstances precipitating requests for refills of naloxone. Qualitative in-depth interviews with 150 IDUs (100 trained and 50 untrained) will explore rationales for and barriers to enrolling in overdose prevention training, the effects of training participation, differences between training programs, and the effects of participating in an overdose rescue. PUBLIC HEALTH RELEVANCE: The proposed study will fill a critical gap in the public health literature on opioid overdose and the effects of OPPs among IDUs, who are at elevated risk for death due to overdose. Additionally, the study will provide important information about how the effects of participating in overdose prevention training and practicing prevention skills may be associated with non-overdose related health behaviors, such as HIV risk behavior.