社区HEAL干预对减少非致命性阿片类药物过量的有效性：一项预先指定的候补名单集群对照随机对照试验的二次分析

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-04-11 DOI:10.1016/j.drugpo.2025.104798

Louisa Gilbert , Rouba Chahine , Redonna Chandler , Daniel J. Feaster , Erin Kim , Arnie Aldridge , Sarah Bagley , Peter Balvanz , Soledad Fernandez , Peter Rock , Rachel A. Vickers-Smith , Jennifer Villani , Tracy Battaglia , Jennifer Brown , Heather Bush , Rachel P. Chase , Thomas Collins , Lauren D'Costa , Carolyn Damato-MacPherson , James L. David , Nabila El-Bassel

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引用次数: 0

摘要

随着美国阿片类药物过量死亡人数的激增，非致命性阿片类药物过量（NFOO）急诊科（ED）就诊和住院率急剧增加。方法在康复社区研究（HCS）中，我们进行了预先指定的二次分析，以评估社区康复（CTH）干预在减少NFOO ED就诊和住院次数方面的有效性。该研究在肯塔基州、马萨诸塞州、纽约州和纽约州的67个社区进行了多地点聚类随机多地点、两组、平行、社区水平、开放、等待名单对照试验研究。和俄亥俄州随机分为干预组（N = 34）或候补对照组（N = 33），按州分层，按城乡分类、致死性阿片类药物过量率和社区人口规模进行平衡。我们比较了2021年7月1日至2022年6月30日干预社区和对照社区每10万名≥18岁成年人的NFOO率。根据ICD-10-CM代码为阿片类药物中毒的干预社区居民的住院和急诊科记录，以每10万人或每100名成年人口计算发生率。结果与对照社区相比，干预社区人均NFOO减少15% (aRR = 0.85；95% ci = [0.74,0.96]；假定值= 0.013)。州、城乡状况、性别、年龄、种族和民族的影响变化不显著。这些发现表明，干预减少了急诊就诊和住院。缺乏效果修改表明该干预措施可能在美国的广泛社区中有效，需要进一步研究以确定干预措施减少NFOO的机制。临床试验注册号：NCT04111939。

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The effectiveness of the communities that HEAL intervention on reducing non-fatal opioid overdoses: A prespecified secondary analysis of a waitlist cluster control randomized controlled trial

Introduction

Along with a surge of opioid overdose deaths in the United States, the rates of nonfatal opioid overdose (NFOO) emergency department (ED) visits and hospitalizations have been sharply increasing.

Methods

In the HEALing Communities Study (HCS), we conducted a pre-specified secondary analyses to evaluate the effectiveness of the Community that HEALS (CTH) intervention on reducing the count of NFOO ED visits and hospitalizations in a multi-site cluster randomized multi-site, two-arm, parallel, community-level, open, wait list-controlled trial study, Sixty-seven communities in Kentucky, Massachusetts, New York, and Ohio were randomized to the intervention (N = 34) or waitlist control condition (N = 33) stratified by state and balanced by urban/rural classification, fatal opioid overdose rate and population size of communities. We compared the rate of NFOO per 100,000 adults aged ≥18 years between intervention and control communities from July 1, 2021, to June 30, 2022. Rates were calculated in per 100,000 or per 100 adult population measured by inpatient and ED records for intervention community residents with an ICD-10-CM code for opioid poisoning.

Results

Compared to control communities, intervention communities had 15 % fewer NFOO per capita (aRR = 0.85; 95 % CI = [0.74,0.96]; p-value=0.013). Effect modifications by state, urban/rural status, sex, age, race and ethnicity were not significant.

Discussion

These findings suggest the intervention reduced NFOO ED visits and hospitalizations. The lack of effect modifications suggests that the intervention may be effective in a wide range of communities in the U.S. Further research is needed to identify the mechanisms through which the intervention reduces NFOO.

Trial Registration

ClinicalTrials.gov Identifier: NCT04111939.

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.