Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-62, Atlanta, GA 30341, United States.
J Safety Res. 2019 Feb;68:231-237. doi: 10.1016/j.jsr.2018.10.011. Epub 2018 Nov 4.
Since 1999, overdose deaths involving opioids have substantially increased. In 2016, 42,249 opioid-related deaths occurred-a 27.7% increase from the previous year (Hedegaard et al., 2017). As the nation's public health agency, the Centers for Disease Control and Prevention (CDC) has been actively involved in efforts to prevent opioid misuse, opioid use disorder, and opioid overdose since 2014. One of CDC's three principal opioid overdose prevention programs, the Prevention for States (PfS) program, began funding 16 state partners in August 2015 and then expanded to fund a total of 29 states in March 2016. The PfS program aims to prevent opioid morbidity and mortality by implementing evidence-based strategies such as enhancing and maximizing prescription drug monitoring programs (PDMPs) and implementing community or health systems interventions.
In this article, we will describe the origins of the PfS program, provide an overview of program strategies, and locate PfS strategies in the larger landscape of nation-wide opioid overdose prevention efforts advanced by other partners and stakeholders. To describe the implementation of PfS, we offer an iterative model of using information to inform strategy selection, implementation, and evaluation. This model is a product of our observations of program implementation over time and has emerged, post hoc, as a helpful framework for organizing our insights and reflections on the work.
For each step of the model, we provide examples of how CDC has supported funded state partners in these efforts. Lastly, we describe innovative facets of the program and implications for both ongoing and future programs. Practical applications: Opioid overdose morbidity and mortality continues to increase across the United States. Adoption of the strategies and the program implementation paradigm described in this article when implementing prevention activities could improve the ability of public health programs to reverse this trend.
自 1999 年以来,涉及阿片类药物的过量死亡人数大幅增加。2016 年,发生了 42249 例阿片类药物相关死亡事件——比前一年增加了 27.7%(Hedegaard 等人,2017 年)。作为美国的公共卫生机构,疾病预防控制中心(CDC)自 2014 年以来一直积极参与预防阿片类药物滥用、阿片类药物使用障碍和阿片类药物过量的工作。CDC 的三个主要阿片类药物过量预防项目之一,即预防国家(PfS)计划,于 2015 年 8 月开始为 16 个州合作伙伴提供资金,然后于 2016 年 3 月扩大到为总共 29 个州提供资金。PfS 计划旨在通过实施基于证据的策略来预防阿片类药物的发病率和死亡率,例如加强和最大化处方药物监测计划(PDMP)以及实施社区或卫生系统干预措施。
在本文中,我们将描述 PfS 计划的起源,概述计划策略,并将 PfS 策略置于其他合作伙伴和利益相关者推进的全国性阿片类药物过量预防工作的更大背景下。为了描述 PfS 的实施,我们提供了一个迭代模型,该模型使用信息来告知策略选择、实施和评估。该模型是我们对计划实施的观察随着时间的推移而产生的,并且是一个有用的框架,用于组织我们对工作的见解和思考。
对于模型的每一步,我们都提供了 CDC 如何支持资助的州合作伙伴在这些努力中的例子。最后,我们描述了该计划的创新方面以及对当前和未来计划的影响。实际应用:在美国,阿片类药物过量的发病率和死亡率仍在继续上升。在实施预防活动时采用本文所述的策略和计划实施模式可以提高公共卫生计划扭转这一趋势的能力。