Abbas Bilal, Marotta Phillip L, Goddard-Eckrich Dawn, Huang Diane, Schnaidt Jakob, El-Bassel Nabila, Gilbert Louisa
Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States.
Washington University - St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO, 63130, United States.
Drug Alcohol Depend. 2021 Jan 1;218:108388. doi: 10.1016/j.drugalcdep.2020.108388. Epub 2020 Oct 24.
Research on socio-ecological factors that may impede or facilitate access to naloxone in pharmacies remains limited. This study investigated associations between socio-ecological factors, pharmacy participation in the naloxone cost assistance program (NCAP), pharmacy characteristics and having naloxone in stock among pharmacies in New York City.
Phone interviews were conducted with 662 pharmacies selected from the New York City Naloxone Standing Order List. Multi-level generalized linear modeling estimated associations between neighborhood racial and ethnic composition, poverty rates, overdose fatality rates, pharmacy participation in N-CAP, having private physical spaces within the pharmacy, knowledge of where to refer people to obtain naloxone and adjusted relative risk (aRR) that the pharmacy would have naloxone in stock.
Findings from this study supported several of the hypotheses. Greater neighborhood poverty was associated with a lower likelihood of carrying naloxone compared to neighborhoods with less poverty (aRR = .79, CI95 % = .69, .90, p < .001). Pharmacies that provided a private window for consultations (aRR = 1.34, CI95 % = 1.19, 1.51, p < .001), a private room (aRR = 1.42, CI95 % = 1.30, 1.56, p < .001), and a private area (aRR = 1.42, CI95 % = 1.30, 1.56, p < .001) were associated with a higher likelihood of carrying naloxone compared than those that did not.
Findings from this study suggest that community-level socioeconomic marginalization is a contributor to disparities in naloxone availability among pharmacies in New York City. Findings support harm reduction interventions tailored to the built environment of pharmacies that respect privacy to those seeking naloxone.
关于可能阻碍或促进药店获取纳洛酮的社会生态因素的研究仍然有限。本研究调查了纽约市各药店的社会生态因素、药店参与纳洛酮成本援助计划（NCAP）、药店特征与纳洛酮库存之间的关联。
对从纽约市纳洛酮常备订单列表中选取的662家药店进行电话访谈。多层次广义线性模型估计了邻里种族和族裔构成、贫困率、过量用药死亡率、药店参与NCAP、药店内有无私人空间、知晓引导人们获取纳洛酮的地点与药店有纳洛酮库存的调整相对风险（aRR）之间的关联。
本研究的结果支持了几个假设。与贫困程度较低的社区相比，邻里贫困程度较高与药店储备纳洛酮的可能性较低相关（aRR = 0.79，95%置信区间 = 0.69，0.90，p < 0.001）。与没有提供的药店相比，提供私人咨询窗口（aRR = 1.34，95%置信区间 = 1.19，1.51，p < 0.001）、私人房间（aRR = 1.42，95%置信区间 = 1.30，1.56，p < 0.001）和私人区域（aRR = 1.42，95%置信区间 = 1.30，1.56，p < 0.001）的药店储备纳洛酮的可能性更高。
本研究结果表明，社区层面的社会经济边缘化是纽约市各药店纳洛酮可及性差异的一个因素。研究结果支持针对药店建筑环境量身定制的减少伤害干预措施，这些措施尊重寻求纳洛酮者的隐私。
