Morgan Jake R, Freibott Christina E, Jalali Ali, Jeng Philip J, Walley Alexander Y, Chatterjee Avik, Green Traci C, Nolan Michelle L, Linas Benjamin P, Marshall Brandon D L, Murphy Sean M
Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States of America.
Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America.
Drug Alcohol Depend Rep. 2022 Sep;4. doi: 10.1016/j.dadr.2022.100083. Epub 2022 Jul 27.
Naloxone distributed to people at risk for opioid overdose has been associated with reduced overdose death rates; however, associations of retail pharmacy-distributed naloxone with overdose mortality have not been evaluated.
Our analytic cohort uses retail pharmacy claims data; three health departments' community distribution data; federal opioid overdose data; and American Community Survey data. Data were analyzed by 3-digit ZIP Code and calendar quarter-year (2016Q1-2018Q4), and weighted by population. We regressed opioid-related overdose mortality on retail-pharmacy and community naloxone distribution, and community-level demographics using a linear model, hypothesizing that areas with high overdose rates would have higher current levels of naloxone distribution but that increasing naloxone distribution from one quarter to the next would be associated with lower overdose.
From Q1-2016 to Q4-2018, the unadjusted naloxone distribution rate increased from 97 to 257 kits per 100,000 persons, while the unadjusted opioid overdose mortality rate fell from 8.1 to 7.2 per 100,000 persons. The concurrent level of naloxone distribution (both pharmacy and community) was positively and significantly associated with fatal opioid overdose rates. We did not detect associations between change in naloxone distribution rates and overdose mortality.
Naloxone distribution volumes were correlated with fatal opioid overdose, suggesting medication was getting to communities where it was needed most. Amid high rates of overdose driven by fentanyl in the drug supply, our findings suggest additional prevention, treatment, and harm reduction interventions are required-and dramatically higher naloxone volumes needed-to reverse the opioid overdose crisis in the US.
向有阿片类药物过量风险的人群分发纳洛酮与降低过量死亡率有关；然而，零售药店分发的纳洛酮与过量死亡率之间的关联尚未得到评估。
我们的分析队列使用零售药店索赔数据、三个卫生部门的社区分发数据、联邦阿片类药物过量数据和美国社区调查数据。数据按3位邮政编码和日历季度年（2016年第一季度至2018年第四季度）进行分析，并按人口加权。我们使用线性模型对零售药店和社区纳洛酮分发以及社区层面的人口统计学因素进行阿片类药物相关过量死亡率回归分析，假设过量率高的地区当前纳洛酮分发水平会更高，但纳洛酮分发量从一个季度到下一个季度的增加将与较低的过量率相关。
从2016年第一季度到2018年第四季度，未经调整的纳洛酮分发率从每10万人97剂增加到257剂，而未经调整的阿片类药物过量死亡率从每10万人8.1例降至7.2例。纳洛酮分发的同期水平（包括药店和社区）与致命阿片类药物过量率呈正相关且具有统计学意义。我们未发现纳洛酮分发率变化与过量死亡率之间的关联。
纳洛酮分发量与致命阿片类药物过量相关，表明药物已送达最需要的社区。在药物供应中芬太尼导致的高过量率背景下，我们的研究结果表明，需要额外的预防、治疗和减少伤害干预措施，以及大幅增加纳洛酮分发量，以扭转美国的阿片类药物过量危机。
