Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA.
Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA.
Drug Alcohol Depend. 2022 Jan 1;230:109190. doi: 10.1016/j.drugalcdep.2021.109190. Epub 2021 Nov 27.
Naloxone is a prescription medication that reverses opioid overdoses. Allowing naloxone to be dispensed directly by a pharmacist without an individual prescription under a naloxone standing order (NSO) can expand access. The community-level factors associated with naloxone dispensed under NSO are unknown.
Using a dataset comprised of pharmacy reports of naloxone dispensed under NSO from 70% of Massachusetts retail pharmacies, we examined relationships between community-level demographics, rurality, measures of treatment for opioid use disorder, and overdose deaths with naloxone dispensed under NSO per ZIP Code-quarter from 2014 until 2018. We used a multi-variable zero-inflated negative binomial model, assessing odds of any naloxone dispensed under NSO, as well as a multi-variable negative binomial model assessing quantities of naloxone dispensed under NSO.
From 2014-2018, quantities of naloxone dispensed under NSO and the number of pharmacies dispensing any naloxone under NSO increased over time. However, communities with greater percentages of people with Hispanic ethnicity (aOR 0.91, 95% CI 0.86-0.96 per 5% increase), and rural communities compared to urban communities (aOR 0.81, 95% CI 0.73-0.90) were less likely to dispense any naloxone by NSO. Communities with more individuals treated with buprenorphine dispensed more naloxone under NSO, as did communities with more opioid-related overdose deaths.
Naloxone dispensing has substantially increased, in part driven by standing orders. A lower likelihood of naloxone being dispensed under NSO in communities with larger Hispanic populations and in more rural communities suggests the need for more equitable access to, and uptake of, lifesaving medications like naloxone.
纳洛酮是一种可以逆转阿片类药物过量的处方药物。在纳洛酮常备令（NSO）下，允许药剂师无需个人处方即可直接分发纳洛酮，可以扩大其获取途径。但目前尚不清楚与 NSO 下分发纳洛酮相关的社区层面因素。
我们使用了一个由马萨诸塞州 70%的零售药店报告的 NSO 下分发的纳洛酮数据集，研究了社区层面的人口统计学、农村程度、阿片类药物使用障碍治疗措施以及与 2014 年至 2018 年每个邮政编码季度 NSO 下分发的纳洛酮之间的关系。我们使用多变量零膨胀负二项式模型，评估 NSO 下任何纳洛酮的分配概率，以及多变量负二项式模型评估 NSO 下分配的纳洛酮数量。
从 2014 年至 2018 年，NSO 下分发的纳洛酮数量和 NSO 下分发纳洛酮的药店数量随着时间的推移而增加。然而，与城市社区相比，具有较高西班牙裔人口比例（每增加 5%，OR0.91，95%CI0.86-0.96）和农村社区的社区（OR0.81，95%CI0.73-0.90）不太可能通过 NSO 分发任何纳洛酮。接受丁丙诺啡治疗的人数较多的社区，以及阿片类药物相关过量死亡人数较多的社区，通过 NSO 分发的纳洛酮数量也更多。
纳洛酮的分发量大幅增加，部分原因是常备令的推动。在西班牙裔人口比例较高和农村社区中，通过 NSO 分发纳洛酮的可能性较低，这表明需要更公平地获取和使用纳洛酮等救命药物。
