Department of Neurosurgery, University of New Mexico, Albuquerque.
Project ECHO, ECHO Institute, Albuquerque, New Mexico.
JAMA Netw Open. 2020 Feb 5;3(2):e200117. doi: 10.1001/jamanetworkopen.2020.0117.
The US opioid crisis was deemed a public health emergency in 2017. More than 130 individuals in the US die daily as a result of unintentional opioid overdose deaths.
To measure use of take-home naloxone for overdose reversals performed by study participants with opioid use disorder receiving treatment at an opioid treatment program.
DESIGN, SETTING, AND PARTICIPANTS: In a year-long cohort study, between April 4, 2016, and May 16, 2017, 395 study participants enrolled at the University of New Mexico Addiction and Substance Abuse Opioid Treatment Program, an outpatient clinic treating substance use disorders. Inclusion criteria included all patients enrolled at University of New Mexico Addiction and Substance Abuse Opioid Treatment Program during the study enrollment period; positive history of opioid use disorder treated with methadone, buprenorphine, or naltrexone; and age 18 years or older. Exclusion criteria included allergy to naloxone and age younger than 18 years. The study closed 1 year after enrollment, on May 17, 2018. Data analysis was performed from May 2018 to July 2019.
Two doses of take-home naloxone combined with opioid overdose education were provided to study participants.
The primary outcome was to measure the association of take-home naloxone with overdose reversals performed by patients with opioid use disorder enrolled in an opioid treatment program.
We enrolled 395 study participants (270 female [68.4%]; mean [SD] age, 35.4 [12.6] years; 260 [65.8%] with Hispanic white race/ethnicity) in the 1-year prospective trial. Sixty-eight female participants (25.2% of all female participants) were pregnant at the time of enrollment. Seventy-three of the 395 study participants (18.0%) performed 114 overdose reversals in the community. All community reversals were heroin related. Most study participants (86.8%) stated that the person on whom they performed an overdose reversal was a friend, relative, acquaintance, or significant other. In the year before enrollment, only 18 study participants (4.5%) had been prescribed naloxone.
Take-home naloxone as part of overdose education and naloxone distribution provided to patients in an opioid treatment program may be associated with a strategic targeted harm reduction response for reversing opioid overdose-related deaths. Policy makers may consider regulations to mandate overdose education and naloxone distribution in opioid treatment programs.
美国的阿片类药物危机于 2017 年被视为公共卫生紧急事件。美国每天有超过 130 人因意外阿片类药物过量而死亡。
衡量在接受阿片类药物治疗计划治疗的患有阿片类药物使用障碍的研究参与者中，用于逆转过量的家庭携带纳洛酮的使用情况。
设计、地点和参与者：在一项为期一年的队列研究中，2016 年 4 月 4 日至 2017 年 5 月 16 日，395 名研究参与者在新墨西哥大学成瘾和药物滥用阿片类药物治疗计划中登记，这是一家治疗药物使用障碍的门诊诊所。纳入标准包括在研究登记期间在新墨西哥大学成瘾和药物滥用阿片类药物治疗计划登记的所有患者；经美沙酮、丁丙诺啡或纳曲酮治疗的阿片类药物使用障碍阳性病史；年龄在 18 岁或以上。排除标准包括对纳洛酮过敏和年龄小于 18 岁。研究于 2018 年 5 月 17 日登记后 1 年结束。数据分析于 2019 年 5 月至 7 月进行。
为研究参与者提供了两剂家庭携带纳洛酮和阿片类药物过量教育。
主要结果是衡量家庭携带纳洛酮与接受阿片类药物治疗计划治疗的阿片类药物使用障碍患者进行的过量逆转之间的关联。
我们在为期 1 年的前瞻性试验中招募了 395 名研究参与者（270 名女性[68.4%]；平均[SD]年龄 35.4[12.6]岁；260[65.8%]为西班牙裔白人种族/民族）。68 名女性参与者（所有女性参与者的 25.2%）在登记时怀孕。395 名研究参与者中有 73 名（18.0%）在社区中进行了 114 次过量逆转。所有社区逆转均与海洛因有关。大多数研究参与者（86.8%）表示，他们进行过量逆转的人是朋友、亲戚、熟人或重要他人。在登记前的一年中，只有 18 名研究参与者（4.5%）被开了纳洛酮。
作为阿片类药物过量教育和纳洛酮分发计划的一部分，向阿片类药物治疗计划中的患者提供家庭携带纳洛酮可能与针对逆转阿片类药物过量相关死亡的战略有针对性的减少伤害措施有关。政策制定者可能会考虑法规，要求在阿片类药物治疗计划中进行过量教育和纳洛酮分发。
