RTI International, 2150 Shattuck Ave, #800, Berkeley, CA, 94704, USA.
Remedy Alliance, Chapel Hill, NC, USA.
Harm Reduct J. 2022 May 28;19(1):55. doi: 10.1186/s12954-022-00639-z.
Opioid-related overdose deaths have surged in the USA over the last two decades. Overdose fatalities are preventable with the timely administration of naloxone. Syringe service programs (SSP) have pioneered community-based naloxone distribution through overdose prevention and naloxone distribution (OEND) programs. There is a dearth of information with regards to best practices for community-based OEND.
We utilized a modified Delphi approach to develop a set of best practices for OEND delivery. Starting with an initial list of best practices, we engaged 27 experts, in the field of OEND programming who reviewed, made recommendations for changes, and assigned a priority to each best practice.
Two rounds of input resulted in a final list of 20 best practices organized into four categories. The mean priority scores ranged from 1.17 to 2.17 (range 1 to 3). The top 5 ranked best practices were ensuring that SSP participants have low barrier, consistent, needs-based access to naloxone and that there is ample naloxone available within communities. While the remaining fifteen best practices were deemed important, they had more to do with organizational culture and implementation climate.
Increasing community-based OEND delivery is essential to reduce opioid overdose deaths; however, it will be insufficient to add programs without an eye toward quality of implementation and fidelity to the model upon which the evidence is based. This list of best practices summarizes the consensus among OEND experts and can serve as a tool for SSPs providing OEND programming to improve services.
在过去的二十年中，美国与阿片类药物相关的过量死亡人数激增。及时使用纳洛酮可以预防过量死亡。注射服务项目 (SSP) 通过过量预防和纳洛酮分发 (OEND) 项目开创了社区为基础的纳洛酮分发。关于社区为基础的 OEND 的最佳实践，信息匮乏。
我们使用改良 Delphi 方法制定了一套 OEND 交付的最佳实践。从最初的最佳实践列表开始，我们邀请了 27 名 OEND 编程领域的专家参与，他们审查、提出变更建议，并为每个最佳实践分配优先级。
两轮输入后，最终确定了 20 项最佳实践，分为四个类别。平均优先级评分范围为 1.17 至 2.17（范围为 1 至 3）。排名前 5 的最佳实践是确保 SSP 参与者可以低门槛、持续、按需获得纳洛酮，并且社区内有充足的纳洛酮供应。虽然其余 15 项最佳实践也被认为很重要，但它们更多地与组织文化和实施氛围有关。
增加社区为基础的 OEND 交付对于减少阿片类药物过量死亡至关重要；然而，如果不关注实施质量和对证据所依据的模式的保真度，仅仅增加项目是不够的。这份最佳实践清单总结了 OEND 专家的共识，可以作为为 OEND 编程提供服务的 SSP 的工具，以改善服务。
