Columbia University, Department of Epidemiology, 722 W. 168th St. New York, NY, 10032, USA.
NYU Grossman School of Medicine, Department of Population Health, 180 Madison Avenue 4th Floor, New York, NY 10016, USA.
Int J Drug Policy. 2023 Apr;114:103980. doi: 10.1016/j.drugpo.2023.103980. Epub 2023 Feb 28.
Naloxone distribution is central to ongoing efforts to address the opioid overdose crisis. Some critics contend that naloxone expansion may inadvertently promote high-risk substance use behaviors among adolescents, but this question has not been directly investigated.
We examined relationships between naloxone access laws and pharmacy naloxone distribution with lifetime heroin and injection drug use (IDU), 2007-2019. Models generating adjusted odds ratios (aOR) and 95% confidence intervals (CI) included year and state fixed effects, controlled for demographics and sources of variation in opioid environments (e.g., fentanyl penetration), as well as additional policies expected to impact substance use (e.g., prescription drug monitoring). Exploratory and sensitivity analyses further examined naloxone law provisions (e.g., third-party prescribing) and applied e-value testing to assess vulnerability to unmeasured confounding.
Adoption of any naloxone law was not associated with changes in adolescent lifetime heroin or IDU. For pharmacy dispensing, we observed a small decrease in heroin use (aOR: 0.95 [CI: 0.92, 0.99]) and a small increase in IDU (aOR: 1.07 [CI: 1.02, 1.11]). Exploratory analyses of law provisions suggested that third-party prescribing (aOR: 0.80, [CI: 0.66, 0.96]) and non-patient-specific dispensing models (aOR: 0.78, [CI: 0.61, 0.99]) were associated with decreased heroin use but not decreased IDU. Small e-values associated with the pharmacy dispensing and provision estimates indicate that unmeasured confounding may explain observed findings.
Naloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages.
纳洛酮的分发是解决阿片类药物过量危机的持续努力的核心。一些批评者认为，纳洛酮的扩张可能会无意中促进青少年的高风险物质使用行为，但这个问题尚未得到直接调查。
我们研究了纳洛酮获取法和药店纳洛酮分发与 2007 年至 2019 年期间青少年终生海洛因和注射药物使用（IDU）之间的关系。生成调整后的优势比（aOR）和 95%置信区间（CI）的模型包括年份和州固定效应，控制了人口统计学因素以及阿片类药物环境中变异的来源（例如芬太尼渗透），以及预计会影响物质使用的其他政策（例如，处方药物监测）。探索性和敏感性分析进一步研究了纳洛酮法的规定（例如，第三方处方），并应用 e 值测试来评估对未测量混杂因素的脆弱性。
任何纳洛酮法的采用都与青少年终生海洛因或 IDU 无变化相关。对于药店配药，我们观察到海洛因使用略有减少（aOR：0.95 [CI：0.92，0.99]），IDU 略有增加（aOR：1.07 [CI：1.02，1.11]）。对法律规定的探索性分析表明，第三方处方（aOR：0.80 [CI：0.66，0.96]）和非患者特异性配药模型（aOR：0.78 [CI：0.61，0.99]）与海洛因使用减少相关，但与 IDU 减少无关。与药店配药和规定估计相关的小 e 值表明，未测量的混杂因素可能解释了观察到的发现。
纳洛酮的获取法和药店纳洛酮的分发与青少年终生海洛因和 IDU 的减少而不是增加更一致相关。因此，我们的研究结果并不支持纳洛酮的获取会促进青少年的高风险物质使用行为的担忧。截至 2019 年，所有美国州都通过了立法，以改善纳洛酮的获取并促进其使用。然而，鉴于阿片类药物流行继续影响所有年龄段的人，进一步消除青少年获取纳洛酮的障碍是一个重要的优先事项。
