Lewis Christa R, Vo Hoa T, Fishman Marc
Maryland Treatment Centers, Baltimore, MD, USA.
Department of Psychology, Towson University, Towson, MD, USA.
Subst Abuse Rehabil. 2017 Oct 11;8:79-95. doi: 10.2147/SAR.S101700. eCollection 2017.
Deaths due to prescription and illicit opioid overdose have been rising at an alarming rate, particularly in the USA. Although naloxone injection is a safe and effective treatment for opioid overdose, it is frequently unavailable in a timely manner due to legal and practical restrictions on its use by laypeople. As a result, an effort spanning decades has resulted in the development of strategies to make naloxone available for layperson or "take-home" use. This has included the development of naloxone formulations that are easier to administer for nonmedical users, such as intranasal and autoinjector intramuscular delivery systems, efforts to distribute naloxone to potentially high-impact categories of nonmedical users, as well as efforts to reduce regulatory barriers to more widespread distribution and use. Here we review the historical and current literature on the efficacy and safety of naloxone for use by nonmedical persons, provide an evidence-based discussion of the controversies regarding the safety and efficacy of different formulations of take-home naloxone, and assess the status of current efforts to increase its public distribution. Take-home naloxone is safe and effective for the treatment of opioid overdose when administered by laypeople in a community setting, shortening the time to reversal of opioid toxicity and reducing opioid-related deaths. Complementary strategies have together shown promise for increased dissemination of take-home naloxone, including 1) provision of education and training; 2) distribution to critical populations such as persons with opioid addiction, family members, and first responders; 3) reduction of prescribing barriers to access; and 4) reduction of legal recrimination fears as barriers to use. Although there has been considerable progress in decreasing the regulatory and legal barriers to effective implementation of community naloxone programs, significant barriers still exist, and much work remains to be done to integrate these programs into efforts to provide effective treatment of opioid use disorders.
因处方类和非法阿片类药物过量导致的死亡人数一直在以惊人的速度上升，尤其是在美国。尽管纳洛酮注射是治疗阿片类药物过量的一种安全有效的方法，但由于外行人使用纳洛酮存在法律和实际限制，纳洛酮往往无法及时获得。因此，历经数十年的努力，已制定出一些策略，以使纳洛酮可供外行人使用或“带回家”使用。这包括开发更便于非医疗使用者给药的纳洛酮制剂，如鼻内给药和自动注射器肌内给药系统；努力将纳洛酮分发给可能产生重大影响的非医疗使用者群体；以及努力减少更广泛分发和使用纳洛酮的监管障碍。在此，我们回顾关于非医疗人员使用纳洛酮的疗效和安全性的历史及当前文献，基于证据讨论有关带回家使用的不同剂型纳洛酮的安全性和疗效的争议，并评估当前增加其公众分发的努力的现状。当由社区环境中的外行人给药时，带回家使用的纳洛酮对于治疗阿片类药物过量是安全有效的，可缩短阿片类药物毒性逆转的时间并减少与阿片类药物相关的死亡。互补策略共同显示出增加带回家使用的纳洛酮传播的前景，包括：1）提供教育和培训；2）分发给关键人群，如阿片类药物成瘾者、家庭成员和急救人员；3）减少获取药物的处方障碍；4）减少对法律指控的恐惧这一使用障碍。尽管在减少社区纳洛酮项目有效实施的监管和法律障碍方面已取得相当大的进展，但重大障碍仍然存在，要将这些项目纳入提供阿片类药物使用障碍有效治疗的努力中，仍有许多工作要做。
