Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLoS One. 2020 Mar 11;15(3):e0230127. doi: 10.1371/journal.pone.0230127. eCollection 2020.
Overdose is a leading cause of death in the United States, especially among people who inject drugs (PWID). Improving naloxone access and carrying among PWID may offset recent increases in overdose mortality associated with the influx of synthetic opioids in the drug market. This study characterized prevalence and correlates of several naloxone outcomes among PWID.
During 2018, a survey to assess experience with naloxone was administered to 915 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study, an ongoing community-based observational cohort of people who currently inject or formerly injected drugs in Baltimore, Maryland. We examined the associations of naloxone outcomes (training, supply, use, and regular possession) with socio-demographic, substance use and healthcare utilization factors among PWID in order to characterize gaps in naloxone implementation among this high-risk population.
Median age was 56 years, 34% were female, 85% were African American, and 31% recently injected. In the past six months, 46% (n = 421) reported receiving training in overdose prevention, 38% (n = 346) had received a supply of naloxone, 9% (n = 85) had administered naloxone, and 9% (n = 82) reported usually carrying a supply of naloxone. Recent non-fatal overdose was not associated with any naloxone outcomes in adjusted analysis. Active opioid use (aOR = 2.10, 95% CI: 1.03, 4.28) and recent treatment of alcohol or substance use disorder (aOR = 2.01, 95% CI: 1.13, 3.56) were associated with regularly carrying naloxone.
Further work is needed to encourage PWID to carry and effectively use naloxone to decrease rates of fatal opioid overdose. While accessing treatment for substance use disorder was positively associated with carrying naloxone, EMS response to 911 calls for overdose, the emergency department, and syringe services programs may be settings in which naloxone access and carrying could be encouraged among PWID.
在美国，过量用药是导致死亡的主要原因，尤其是在注射毒品者（PWID）中。提高 PWID 对纳洛酮的获取和携带率可能会抵消因药物市场中合成阿片类药物涌入而导致的最近过量用药死亡率的上升。本研究描述了 PWID 中几种纳洛酮结果的流行率和相关性。
在 2018 年，对马里兰州巴尔的摩市正在进行的基于社区的 AIDS Linked to the IntraVenous Experience（ALIVE）研究中的 915 名参与者进行了一项评估纳洛酮使用经验的调查。我们研究了纳洛酮结果（培训、供应、使用和常规持有）与 PWID 中社会人口统计学、药物使用和医疗保健利用因素之间的关联，以便描述高危人群中纳洛酮实施方面的差距。
中位年龄为 56 岁，34%为女性，85%为非裔美国人，31%最近注射过毒品。在过去六个月中，46%（n=421）报告接受过过量预防培训，38%（n=346）收到过纳洛酮供应，9%（n=85）曾使用过纳洛酮，9%（n=82）报告经常携带纳洛酮供应。在调整分析中，最近非致命性过量用药与任何纳洛酮结果均无关。阿片类药物的活跃使用（aOR=2.10，95%CI：1.03，4.28）和最近治疗酒精或物质使用障碍（aOR=2.01，95%CI：1.13，3.56）与经常携带纳洛酮有关。
需要进一步努力鼓励 PWID 携带并有效使用纳洛酮，以降低致命阿片类药物过量用药的发生率。虽然接受物质使用障碍治疗与携带纳洛酮呈正相关，但紧急医疗服务部门对 911 过量用药呼叫的反应、急诊室和注射器服务项目可能是鼓励 PWID 获得和携带纳洛酮的场所。
