RTI-International, 351 California St, Suite 500, San Francisco, CA, 94104, USA; University of California San Francisco, 1500 Owens St, San Francisco, CA, 94158, USA; University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
Network for Public Health Law, 7101 York Avenue South, Edina, MN, 55435, USA.
Drug Alcohol Depend. 2018 Jul 1;188:370-376. doi: 10.1016/j.drugalcdep.2018.04.004. Epub 2018 May 15.
BACKGROUND: The opioid overdose crisis in the United States continues to worsen. Opioid overdose mortality is entirely preventable with timely administration of naloxone. Since 2001, many states have passed laws to create an enabling environment for the implementation of overdose education and naloxone distribution (OEND) programs. We assessed whether state-level naloxone laws and their provisions stimulated the implementation of OEND programs in the United States. METHODS: Covering the period from 2000 to 2014, we utilized five data sources including the Westlaw legal database, the Prescription Drug Abuse Policy System, the Harm Reduction Coalition's OEND database, National Center of Health Statistics and the United States Census. Random effects logistic regression models with robust variances were used to examine the association of naloxone access laws and their provisions with OEND program implementation as of 2014. RESULTS: At the end of 2014, 8% of counties had OEND programs implemented within them. Counties within states that had a naloxone law (aOR = 28.98; p < 0.001) or a law with any one of the six provisions - third party (aOR = 12.86; p = 0.001), standing order (aOR = 11.45; p < 0.001), possession (aOR = 45.97; p < 0.001), prescriber immunity (aOR = 5.19; p = 0.007), dispenser immunity (aOR = 3.50; p = 0.028) or layperson dispensing (aOR = 12.91; p = 0.001) - had increased odds of an OEND program implemented within them, compared to counties within states without a law or specific provision, respectively. CONCLUSION: Our findings suggest that naloxone laws facilitated the implementation of OEND programs. With only 8% of counties having an OEND program within them, future studies should investigate strategies to improve the implementation of OEND programs.
背景:美国的阿片类药物过量危机仍在恶化。纳洛酮的及时使用可以完全预防阿片类药物过量死亡。自 2001 年以来,许多州都通过了法律,为实施过量用药教育和纳洛酮分发(OEND)计划创造有利环境。我们评估了州级纳洛酮法律及其规定是否刺激了美国 OEND 计划的实施。
方法:研究覆盖 2000 年至 2014 年期间,利用包括 Westlaw 法律数据库、处方药物滥用政策系统、减少伤害联盟的 OEND 数据库、国家卫生统计中心和美国人口普查在内的五个数据源。采用具有稳健方差的随机效应逻辑回归模型,检验 2014 年纳洛酮获取法律及其规定与 OEND 计划实施之间的关联。
结果:截至 2014 年底,8%的县实施了 OEND 计划。在有纳洛酮法律的州内的县(aOR=28.98;p<0.001)或有以下六项规定之一的州内的县 - 第三方(aOR=12.86;p=0.001)、医嘱(aOR=11.45;p<0.001)、占有(aOR=45.97;p<0.001)、医师豁免权(aOR=5.19;p=0.007)、药剂师豁免权(aOR=3.50;p=0.028)或非专业人员分发(aOR=12.91;p=0.001) - 实施 OEND 计划的可能性高于没有法律或具体规定的州内的县。
结论:我们的研究结果表明,纳洛酮法律促进了 OEND 计划的实施。只有 8%的县实施了 OEND 计划,未来的研究应该调查改善 OEND 计划实施的策略。
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