Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, IN, 46202, USA.
Economics, Sociology, and Statistics Department, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
Harm Reduct J. 2022 Jun 8;19(1):64. doi: 10.1186/s12954-022-00645-1.
Expanding availability to naloxone is a core harm reduction strategy in efforts to address the opioid epidemic. In the US, state-level legislation is a prominent mechanism to expand naloxone availability through various venues, such as community pharmacies. This qualitative study aimed to identify and summarize the views of experts on state-level naloxone access laws.
We conducted a three-round modified-Delphi process using the online ExpertLens platform. Participants included 46 key stakeholders representing various groups (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with expertise naloxone access laws. Participants commented on the effectiveness and implementability of 15 state-level naloxone access laws (NALs). We thematically analyzed participant comments to summarize views on NALs overall and specific types of NAL.
Participants commented that the effectiveness of NALs in reducing opioid-related mortality depends on their ability to make sustained, significant impacts on population-level naloxone availability. Participants generally believed that increased naloxone availability does not have appreciable negative impacts on the prevalence of opioid misuse, opioid use disorder (OUD), and non-fatal opioid overdoses. Implementation barriers include stigma among the general public, affordability of naloxone, and reliance on an inequitable healthcare system.
Experts believe NALs that significantly increase naloxone access are associated with less overdose mortality without risking substantial unintended public health outcomes. To maximize impacts, high-value NALs should explicitly counter existing healthcare system inequities, address stigmatization of opioid use and naloxone, maintain reasonable prices for purchasing naloxone, and target settings beyond community pharmacies to distribute naloxone.
扩大纳洛酮的可及性是解决阿片类药物流行的核心减少伤害策略。在美国，州级立法是通过各种途径（如社区药房）扩大纳洛酮可及性的主要机制。本定性研究旨在确定和总结专家对州级纳洛酮准入法的看法。
我们使用在线 ExpertLens 平台进行了三轮改良 Delphi 过程。参与者包括 46 名具有纳洛酮准入法专业知识的主要利益攸关方，代表各种群体（倡导者、医疗保健提供者、人类/社会服务从业者、政策制定者和研究人员）。参与者对 15 项州级纳洛酮准入法（NAL）的有效性和可操作性发表了评论。我们对参与者的评论进行了主题分析，以总结对 NAL 总体和特定类型 NAL 的看法。
参与者评论说，NAL 降低阿片类相关死亡率的有效性取决于其在人群层面上持续、显著影响纳洛酮可及性的能力。参与者普遍认为，增加纳洛酮的可及性不会对阿片类药物滥用、阿片类药物使用障碍（OUD）和非致命性阿片类药物过量的流行产生明显的负面影响。实施障碍包括公众普遍存在的污名化、纳洛酮的可负担性以及对不平等医疗体系的依赖。
专家认为，显著增加纳洛酮可及性的 NAL 与减少过量死亡有关，而不会带来重大的意外公共卫生后果。为了最大限度地发挥影响，高价值的 NAL 应明确对抗现有的医疗体系不平等，解决阿片类药物使用和纳洛酮的污名化问题，保持购买纳洛酮的合理价格，并针对社区药房以外的场所分配纳洛酮。
