Thesis (Ph.D.)--Tufts University, 2005. / Adviser: Robin B. Kanarek. Submitted to the Dept. of Psychology. Includes bibliographical references (leaves 79-91). Access restricted to members of the Tufts University community. Also available via the World Wide Web;

Opioid users are an at-risk community. Risk of opioid overdose among substance users has increased tremendously in the last decade. Many factors, including adulterated drugs and hesitation in calling emergency response services, have led to many individuals not receiving the required harm reduction treatment, during an overdose incident. The problem is further compounded by the fact that many users are using alone in private residences and hence, no support mechanisms are available for them to assist them in case of an overdose situation. To circumvent this scenario, citizen training in Naloxone, an overdose harm reduction drug, has been promoted. However, there lies an essential communication gap between the citizens who have the training and the Naloxone kit and an active overdose event. Many at-risk communities may face the same challenge, especially if they are at risk of social isolation and voluntary/involuntary self-harm. Through our work, we wish to mobilize change in such at-risk communities, by studying the backend infrastructure of a crowdsourced emergency response system, called as a Peer Alerting Lifeline. The system would be responsible, for connecting peer responders, to an actual emergency event. Specifically, in the case of substance overdose, this would allow Naloxone kit holders to be informed of an overdose event in their vicinity and respond to the same. We aim to study the design infrastructure of such a system. / Graduate

A series of experiments was performed to determine the effects of naloxone on the acquisition of conditioned suppression in rats. Conditioned suppression acquisition functions are often nonmonotonic due to within-session performance decrements and to postasymptotic performance decrements. Naloxone given during acquisition increased post-US suppression (Experiment 1 ) , depressed baseline response rates in a situation involving shock presentation (Experiments 1 and 2b) t eliminated the postasymptotic performance decrement (Experiment 1), and caused greater resistance to extinction than did saline (Experiments 1 and 2b). Naloxone did not eliminate within-session decrements (Experiment 1 and 2b) and failed to affect extinction of conditioned suppression when administered only during extinction (Experiments 1 and 3). Naloxone sliightly decreased baseline responding for sucrose reinforcement. (Experiment 2a), but this effect was a small one and did not confound the effects of naloxone on conditioned suppression. The results suggest that naloxone affects the acquisition of conditioned suppression by increasing the aversiveness of the shock US. The possible role of the activation of an endorphinergic system during fear conditioning is discussed.

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BACKGROUND: Naloxone, an opioid antagonist, offers a powerful tool for preventing opioid overdose deaths. Because studies have shown opioid overdose education and naloxone distribution (OEND) programs to be a safe, feasible, and effective intervention, several policymakers and public health agencies have advocated for broader access to this life-saving medication. Community health centers (CHCs) are a promising location for expanding naloxone access. This investigation examined the experience of CHC-based HIV primary care teams with a variety of overdose education and naloxone access (OENA) strategies in order to inform future dissemination efforts. METHODS: A mixed methods study was conducted with eight CHCs located in Massachusetts communities experiencing high opioid overdose fatality rates. Individual and group interviews with 29 clinic staff members; clinic and participant surveys; and document review were used to elucidate the OENA strategies. The Consolidated Framework for Implementation Research guided the data collection process and subsequent analysis, which revealed several factors supporting or hindering implementation of OENA activities in CHC primary care settings. RESULTS: Operating in a facilitative state policy environment, the CHCs utilized a mix of approaches to OENA: providing clinic-based services, issuing prescriptions, utilizing pharmacy standing orders, and making referrals to existing community-based OEND programs. With prescribers having limited time and competing priorities, nurses, health educators, and other staff played a prominent role in OENA. Pharmacies also served as important access points for patients and community residents. Several strategies were used to engage patients, including active outreach, partnerships with external organizations, and efforts to destigmatize substance use disorders. Clinic staff participation was enhanced through leadership support for harm reduction approaches, ongoing training, peer modeling, and information sharing. CONCLUSIONS: This study demonstrated that OENA can be integrated into CHC primary care services, adapted to the clinic context, and modified as needed. Successful implementation required a systems-level response, grounded in a team-based care model and a consideration of patient needs. The process for naloxone reimbursement needs to be determined to minimize CHC or patient barriers and ensure sustainability. Clinic training and technical assistance plans should be customized according to the staff members’ potential roles and their stage of readiness.