Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA, 94720, USA; Community Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA.
Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA, 90033, USA.
Drug Alcohol Depend. 2021 Aug 1;225:108759. doi: 10.1016/j.drugalcdep.2021.108759. Epub 2021 May 21.
Opioid overdoses are a leading cause of injury death in the United States. Providing people who inject drugs (PWID) with naloxone is essential to preventing deaths. However, research regarding gaps in naloxone delivery is limited.
We interviewed 536 PWID in San Francisco and Los Angeles, California from 2017 to 2018. We described naloxone engagement and re-engagement cascades, and identified factors associated with receiving naloxone in the past six months and currently owning naloxone.
The engagement cascade showed 72 % of PWID ever received naloxone, 49 % received it in the past six months, and 35 % currently owned naloxone. The re-engagement cascade showed, among PWID who received naloxone in the past six months, 74 % used and/or lost naloxone, and 67 % refilled naloxone. In multivariable analyses, identifying as Latinx (aRR = 0.53; 95 % CI: 0.39, 0.72) and Black (aRR = 0.73; 95 % CI: 0.57, 0.94) vs White were negatively associated with receiving naloxone in the past six months, while using opioids 1-29 times (aRR = 1.35; 95 % CI: 1.04, 1.75) and 30+ times (aRR = 1.52; 95 % CI: 1.17, 1.99) vs zero times in the past 30 days and witnessing an overdose in the past six months (aRR = 1.69; 95 % CI: 1.37, 2.08) were positively associated with receiving naloxone in the past six months. In multivariable analyses, being unhoused vs housed (aRR = 0.82; 95 % CI: 0.68, 0.99) was negatively associated with currently owning naloxone.
Our study adds to the literature by developing naloxone engagement and re-engagement cascades to identify disparities. Naloxone scale-up should engage populations facing inequitable access, including people of color and those experiencing homelessness.
阿片类药物过量是美国导致伤害死亡的主要原因。为注射吸毒者（PWID）提供纳洛酮对于预防死亡至关重要。然而，关于纳洛酮提供方面差距的研究有限。
我们在 2017 年至 2018 年期间对加利福尼亚州旧金山和洛杉矶的 536 名 PWID 进行了访谈。我们描述了纳洛酮的使用和重新使用的级联，确定了过去六个月内接受纳洛酮和目前拥有纳洛酮的相关因素。
使用级联显示，72%的 PWID 曾经接受过纳洛酮，49%的人在过去六个月内接受过纳洛酮，35%的人目前拥有纳洛酮。重新使用级联显示，在过去六个月内接受过纳洛酮的 PWID 中，74%的人使用过和/或丢失过纳洛酮，67%的人重新补充过纳洛酮。在多变量分析中，与白人相比，拉丁裔（aRR=0.53；95%CI：0.39，0.72）和黑人（aRR=0.73；95%CI：0.57，0.94）的身份与过去六个月内接受纳洛酮的情况呈负相关，而过去 30 天内使用阿片类药物 1-29 次（aRR=1.35；95%CI：1.04，1.75）和 30 次以上（aRR=1.52；95%CI：1.17，1.99）与零次相比，以及过去六个月内目睹过过量用药（aRR=1.69；95%CI：1.37，2.08）与过去六个月内接受纳洛酮的情况呈正相关。在多变量分析中，与有住房的人相比，无住房的人（aRR=0.82；95%CI：0.68，0.99）与目前拥有纳洛酮的情况呈负相关。
我们的研究通过开发纳洛酮的使用和重新使用级联来确定差异，从而为文献增添了新的内容。纳洛酮的扩大使用应该涉及到面临不公平获取机会的人群，包括有色人种和无家可归者。
