Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
School of Public Health, Health Research Center, Robert C Byrd Health Science Center, West Virginia University, Morgantown, West Virginia, USA.
Inj Prev. 2021 Aug;27(4):369-374. doi: 10.1136/injuryprev-2020-043666. Epub 2020 Sep 1.
Overdose education and naloxone distribution programmes are known to reduce opioid-related deaths. A state-wide naloxone distribution effort of 8250 rescue kits was undertaken by government, community and university partners in West Virginia in 2016-2017. The purpose of this study was to discern the barriers, facilitators and lesson learnt from implementing this endeavour in a rural state with the highest opioid overdose fatality rate in the US.
Structured interviews (n=26) were conducted among both internal and external stakeholders. Those who participated were >18 years of age and were the lead representative from agencies that either received naloxone (ie, external stakeholders) or helped implement the distribution (ie, internal stakeholders). The interviews followed standardised scripts and lasted approximately 40 min. Sessions were audio-recorded and transcribed. Qualitative content analysis was performed by two researchers to determine themes surrounding facilitators or barriers to programme implementation.
The primary facilitators reported by stakeholders included collaborative partnerships, ease of participating in the programme, being established in prevention efforts, demand for naloxone and the need for personal protection from overdose. The primary barriers identified by stakeholders included bureaucracy/policy/procedures of their organisation or agency, stigma, logistical or planning issues, problems with reporting, lack of communication post distribution and sustainability. Numerous lessons were learnt.
Based on the implementation of the programme in 87 organisations, including law enforcement and fire departments, the impact of facilitators outweighed that of barriers. These findings may inform others planning to conduct a similar, large-scale project.
众所周知，过量用药教育和纳洛酮分发计划可降低阿片类药物相关死亡人数。2016-2017 年，西弗吉尼亚州的政府、社区和大学合作伙伴开展了一项全州范围内的纳洛酮分发工作，分发了 8250 个救援包。本研究旨在了解在全美阿片类药物过量死亡率最高的农村州实施这一计划的障碍、促进因素和经验教训。
对 26 名内部和外部利益相关者进行了结构化访谈。参与者年龄均>18 岁，且是接受纳洛酮的机构（即外部利益相关者）或帮助实施该分发计划的机构（即内部利益相关者）的主要代表。访谈遵循标准脚本，持续约 40 分钟。会议进行了录音，并进行了转录。两位研究人员对定性内容进行了分析，以确定围绕计划实施的促进因素或障碍的主题。
利益相关者报告的主要促进因素包括合作伙伴关系、参与计划的便利性、在预防工作中的地位、对纳洛酮的需求以及对避免过量用药的个人保护需求。利益相关者确定的主要障碍包括其组织或机构的官僚主义/政策/程序、耻辱感、后勤或规划问题、报告问题、分发后沟通不畅以及可持续性问题。从中吸取了许多教训。
根据在包括执法和消防部门在内的 87 个组织中实施该计划的情况，促进因素的影响超过了障碍的影响。这些发现可能为其他计划开展类似的大规模项目提供参考。
