Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
DC Center for AIDS Research, Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA.
Ann Med. 2022 Dec;54(1):2692-2700. doi: 10.1080/07853890.2022.2121418.
Implementing public health vending machines (PHVMs) is an evidence-based strategy for mitigating substance use-associated morbidity and mortality the dispensation of essential supplies to people who use drugs, including overdose prevention resources. PHVMs have been implemented throughout the world; however, their implementation in the United States (US) is a recent phenomenon. In 2017, Trac-B Exchange (a syringe services program in Clark County, Nevada) installed three PHVMs. In 2019, naloxone dispensation was launched at PHVMs in Clark County. The purpose of this research is to examine the extent to which naloxone dispensation at PHVMs was associated with changes in opioid-involved overdose fatalities.
Monthly counts of opioid-involved overdose fatalities among Clark County residents that occurred from January 2015 to December 2020 were used to build an autoregressive integrated moving averages (ARIMA) model to measure the impact of naloxone dispensation at PHVMs. We forecasted the number of expected opioid-involved overdose fatalities had naloxone dispensation at PHVMs not occurred and compared to observed monthly counts. Interrupted time series analyses (ITSA) were used to evaluate the step (i.e. the immediate impact of naloxone dispensation at PHVMs on opioid-involved overdose fatalities) and slope change (i.e. changes in trend and directionality of monthly counts of opioid-involved overdose fatalities following naloxone dispensation at PHVMs).
During the 12-months immediately following naloxone dispensation at PHVMs, our model forecasted 270 opioid-involved overdose fatalities, but death certificate data indicated only 229 occurred, suggesting an aversion of 41 deaths. ITSA identified a significant negative step change in opioid-involved overdose fatalities at the time naloxone dispensation at PHVMs was launched (B = -8.52, = .0022) and a significant increasing slope change ( = 1.01, <.0001). Forecasts that extended into the COVID-19 pandemic suggested worsening trends in overdose fatalities.
Naloxone dispensation at PHVMs was associated with immediate reductions in opioid-involved overdose fatalities. Key MessagesNaloxone dispensation at PHVMs was associated with immediate reductions in opioid-involved overdose fatalities.Communities should consider implementing public health vending machines in efforts to prevent opioid-involved overdose fatalities.The COVID-19 pandemic worsened the overdose crisis.
实施公共卫生自动售货机（PHVM）是减轻与物质使用相关的发病率和死亡率的循证策略，包括向吸毒者提供基本用品，包括过量预防资源。PHVM 已在世界各地实施；然而，它们在美国（US）的实施是最近的现象。2017 年，Trac-B Exchange（内华达州克拉克县的一个注射器服务项目）安装了三台 PHVM。2019 年，PHVM 在克拉克县推出了纳洛酮配给。本研究的目的是考察 PHVM 中纳洛酮配给与阿片类药物相关的过量死亡人数变化之间的关联程度。
使用 2015 年 1 月至 2020 年 12 月期间克拉克县居民阿片类药物相关过量死亡的每月计数来构建自回归综合移动平均（ARIMA）模型，以衡量 PHVM 中纳洛酮配给的影响。我们预测了如果 PHVM 中没有纳洛酮配给，预计会发生多少阿片类药物相关的过量死亡，并将其与观察到的每月计数进行比较。中断时间序列分析（ITSA）用于评估步骤（即 PHVM 中纳洛酮配给对阿片类药物相关过量死亡的即时影响）和斜率变化（即 PHVM 中纳洛酮配给后阿片类药物相关过量死亡的趋势和方向变化）。
在 PHVM 中纳洛酮配给后的 12 个月内，我们的模型预测了 270 例阿片类药物相关的过量死亡，但死亡证明数据显示只有 229 例发生，表明有 41 人死亡。ITSA 发现，PHVM 中纳洛酮配给时，阿片类药物相关过量死亡的负向变化具有统计学意义（B=−8.52，=0.0022），斜率变化呈显著增加趋势（=1.01，<0.0001）。扩展到 COVID-19 大流行的预测表明，过量死亡人数呈恶化趋势。
PHVM 中纳洛酮的配给与阿片类药物相关的过量死亡人数的立即减少有关。关键信息 PHVM 中纳洛酮的配给与阿片类药物相关的过量死亡人数的立即减少有关。社区应考虑实施公共卫生自动售货机，以预防阿片类药物相关的过量死亡。COVID-19 大流行使过量危机恶化。
