Chimbar Lisa, Moleta Yvette
Lisa Chimbar, BSN, RN, CCRN, and Yvette Moleta, BSN, RN, Simmons College, Boston, MA.
J Addict Nurs. 2018 Jul/Sep;29(3):167-171. doi: 10.1097/JAN.0000000000000230.
Opioid abuse and overdose is a public health concern as it relates to increased morbidity and mortality. This systematic review focuses on the application of take-home naloxone programs and its association with decreased mortality among those who abuse opioids. Take-home naloxone programs consist of distributed naloxone kits and corresponding education of overdose recognition. The purpose of this systematic review was to determine if programs that supply take-home naloxone are effective in preventing fatal overdoses among those who abuse opioids.
A systematic search was conducted in Academic Search Complete, CINHAL, MEDLINE, PsychINFO, and SocINDEX. The key words searched were "programs," "take-home kits," "Narcan," "Naloxone," and "mortality." On the basis of the predefined inclusion and exclusion criteria, nine studies were found for inclusion.
Study results were then synthesized, qualitatively, and within the current research, there is overwhelming support of take-home naloxone programs being effective in preventing fatal opioid overdoses. A significant limitation of this systematic review is the lack of randomized controlled trials as it is viewed as unethical withholding a known lifesaving medication from an at-risk population.
On the basis of the most current evidence, there is overwhelming support of take-home naloxone programs associated with decreased mortality among those who abuse opioids. As a result, there is an implication for a practice change that take-home naloxone programs should be more widely implemented throughout communities as a method of decreasing mortality associated with opioid overdoses. It is recommended that further research is done examining the cost-effectiveness of these programs.
阿片类药物滥用和过量使用是一个公共卫生问题，因为它与发病率和死亡率的增加有关。本系统评价聚焦于居家使用纳洛酮项目的应用及其与阿片类药物滥用者死亡率降低之间的关联。居家使用纳洛酮项目包括分发纳洛酮试剂盒以及对过量用药识别的相应教育。本系统评价的目的是确定提供居家使用纳洛酮的项目在预防阿片类药物滥用者致命过量用药方面是否有效。
在《学术搜索完整版》《护理学与健康领域数据库》《医学索引》《心理学文摘数据库》和《社会科学期刊索引》中进行了系统检索。检索的关键词为“项目”“居家试剂盒”“纳曲酮”“纳洛酮”和“死亡率”。根据预先定义的纳入和排除标准，发现有9项研究可纳入。
然后对研究结果进行了定性综合，在当前研究中，有压倒性的证据支持居家使用纳洛酮项目在预防致命阿片类药物过量用药方面是有效的。本系统评价的一个重大局限是缺乏随机对照试验，因为从高危人群中 withholding 一种已知的救命药物被视为不道德。
基于最新证据，有压倒性的证据支持居家使用纳洛酮项目与阿片类药物滥用者死亡率降低相关。因此，这意味着应改变做法，居家使用纳洛酮项目应在社区更广泛地实施，作为降低与阿片类药物过量用药相关死亡率的一种方法。建议进一步研究这些项目的成本效益。 （注：“withholding”此处原文有误，可能影响准确理解，推测可能是“withholding”，意为“不给，扣留” ）
