Holland Taylor J, Penm Jonathan, Johnson Jacinta, Sarantou Maria, Chaar Betty B
Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW 2006, Australia.
Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW 2031, Australia.
Pharmacy (Basel). 2020 Dec 3;8(4):232. doi: 10.3390/pharmacy8040232.
Opioid associated death and overdose is a growing burden in societies all over the world. In recent years, legislative changes have increased access to naloxone in the take-home setting for use by patients with a substance use disorder and bystanders, to prevent opioid overdose deaths. However, few studies have explored the factors influencing the uptake by its multiple stakeholders. The aim of this scoping review was to explore the factors influencing the use of take-home naloxone from the perspectives of different stakeholders.
A scoping review methodology was adopted with a systematic search of databases EMBASE, MEDLINE and PubMed. A variation of the search words "naloxone", "opioid" and "overdose" were used in each database. The articles were screened according to the predetermined inclusion/exclusion criteria and categorized based on their key perspective or target population.
The initial database search yielded a total of 1483 articles. After a series of screening processes, 51 articles were included for analysis. Two key stakeholder perspectives emerged: patients and bystanders (n = 36), and healthcare professionals (n = 15). Within the patient and bystander group, a strong consensus arose that there were positive outcomes from increased access to take-home naloxone and relevant training programs. Despite these positive outcomes, some healthcare professionals were concerned that take-home naloxone would encourage high-risk opioid use.
Take-home naloxone is slowly being introduced into community practice, with a sense of enthusiasm from patients and bystanders. There are still a number of barriers that need to be addressed from healthcare professionals' perspective. Future research should be aimed at emergency care professionals outside of the US, who are most experienced with naloxone and its potential impact on the community.
阿片类药物相关的死亡和过量使用在全球社会中造成的负担日益加重。近年来，立法变革使得患有物质使用障碍的患者及其旁观者在院外环境中更容易获得纳洛酮，以预防阿片类药物过量死亡。然而，很少有研究探讨影响其多个利益相关者使用纳洛酮的因素。本综述的目的是从不同利益相关者的角度探讨影响院外使用纳洛酮的因素。
采用综述方法，系统检索EMBASE、MEDLINE和PubMed数据库。在每个数据库中使用了“纳洛酮”、“阿片类药物”和“过量使用”等搜索词的变体。根据预先确定的纳入/排除标准筛选文章，并根据其关键观点或目标人群进行分类。
初步数据库检索共得到1483篇文章。经过一系列筛选过程，纳入51篇文章进行分析。出现了两个关键的利益相关者观点：患者和旁观者（n = 36），以及医疗保健专业人员（n = 15）。在患者和旁观者群体中，人们强烈认为增加院外纳洛酮的可及性和相关培训项目会带来积极成果。尽管有这些积极成果，但一些医疗保健专业人员担心院外纳洛酮会助长高风险的阿片类药物使用。
院外纳洛酮正在慢慢引入社区实践，患者和旁观者对此充满热情。从医疗保健专业人员的角度来看，仍有一些障碍需要解决。未来的研究应针对美国以外的急诊护理专业人员，他们对纳洛酮及其对社区的潜在影响最有经验。
