Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (HSK); Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL (HSK); Department of Emergency Medicine, Cook County Health, Chicago, IL (SEA); Toxikon Consortium, Chicago, IL (SEA).
J Addict Med. 2022;16(1):1-3. doi: 10.1097/ADM.0000000000000821.
The opioid crisis continues to exact a heavy toll on the United States, and overdose deaths have only increased during the current global pandemic. One effective intervention to reduce overdose deaths is to distribute the opioid antagonist naloxone directly to persons actively using opioids (ie, "take-home naloxone"), especially at touchpoints with the potential for significant impact such as emergency departments and jails. A number of hospital emergency departments have recently sought to implement individual take-home naloxone programs; however, programmatic success has been inconsistent due primarily to the inability to secure reliable funding for a naloxone supply. In this commentary, we establish the argument for a publicly funded naloxone supply to support take-home naloxone distribution in emergency department settings. We posit that the complex billing and reimbursement system for medication dispensing is impossibly burdensome during emergency care for an acute opioid overdose, and that the mounting death toll from this public health crisis demands a strong commitment to harm reduction. A publicly financed naloxone supply would demonstrate this commitment and make a measurable impact in saving lives. Ultimately, provision of naloxone should be coupled with other comprehensive treatment services and medications for opioid use disorder to meaningfully reduce harms associated with opioid use.
阿片类药物危机继续给美国造成沉重打击,而且在当前的全球大流行期间,过量用药死亡人数只增不减。减少过量用药死亡的一种有效干预措施是将阿片类药物拮抗剂纳洛酮直接分发给正在积极使用阿片类药物的人(即“携带回家的纳洛酮”),尤其是在有重大影响可能的接触点,如急诊部门和监狱。最近,一些医院急诊部门试图实施个人携带回家的纳洛酮方案;然而,由于无法为纳洛酮供应获得可靠的资金,该方案的实施效果并不一致。在这篇评论中,我们提出了一个由公共资金支持的纳洛酮供应的论点,以支持在急诊部门环境下分发携带回家的纳洛酮。我们认为,在急性阿片类药物过量的急救过程中,药物配给的复杂计费和报销系统令人难以承受,而这场公共卫生危机造成的死亡人数不断增加,要求我们大力致力于减少伤害。公共资金资助的纳洛酮供应将体现这一承诺,并在拯救生命方面产生显著影响。最终,纳洛酮的提供应与其他综合治疗服务和阿片类药物使用障碍的药物相结合,以有意义地减少与阿片类药物使用相关的伤害。