Byregowda Himani, Tomko Catherine, Schneider Kristin E, Russell Erin, Johnson Renee M, Susukida Ryoko, Rouhani Saba, Parnham Taylor, Park Ju Nyeong
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health.
Drug Alcohol Depend Rep. 2023 Jun 16;8:100173. doi: 10.1016/j.dadr.2023.100173.
: Opioid overdose death rates increased during the COVID-19 pandemic. Disruptions in community-based naloxone trainings could have reduced the likelihood of overdose reversal and increased the chances of a fatal overdose. We investigated changes in the number of people trained in naloxone administration and distribution in Maryland before, during, and after COVID-related stay-at-home orders.
: Data on naloxone training are from the Maryland Department of Health. We used interrupted time series models to estimate changes in average monthly number of people trained: [1] pre-interruption (4/2019-3/2020), [2] 1-month post-interruption (4/2020-5/2020), and [3] 12-months post-interruption (4/2020-3/2021). Trainees were classified as lay (e.g., people who use drugs) or occupational (e.g., law enforcement officers and harm reduction workers) responders.
: There were 101,332 trainees; 54.1% lay, 21.5% occupational, and 23.4% unknown responder status. We observed a decrease in the average monthly number of trainees in the pre-interruption period (-235, <0.001), a larger decrease of 93.2% during the 1-month post-interruption (-846, =0.013), and an increase 12-months post-interruption (+217, <0.001). There was a significant decrease among occupational responders 1-month post-interruption, and a significant increase among lay responders in the 12-month post-interruption period.
: Findings suggest a marked decrease in naloxone trainees immediately after stay-at-home order, followed by a moderate rebound in the 12-months after stay-at-home order. The decrease in occupational responders trained may have limited access to naloxone, but would likely have been offset by increases in number of lay responders trained. Strengthening lay and occupational responder connections could maintain naloxone distribution during public health crises.
在新冠疫情期间，阿片类药物过量死亡率有所上升。基于社区的纳洛酮培训中断可能降低了过量用药逆转的可能性，并增加了致命过量用药的几率。我们调查了在与新冠疫情相关的居家令实施之前、期间和之后，马里兰州接受纳洛酮给药和分发培训的人数变化情况。
纳洛酮培训数据来自马里兰州卫生部。我们使用中断时间序列模型来估计平均每月培训人数的变化：[1] 中断前（2019年4月 - 2020年3月），[2] 中断后1个月（2020年4月 - 2020年5月），以及[3] 中断后12个月（2020年4月 - 2021年3月）。培训学员被分为非专业人员（例如，吸毒者）或职业人员（例如，执法人员和减少伤害工作人员）两类应对者。
共有101,332名学员；54.1%为非专业人员，21.5%为职业人员，23.4%的应对者身份不明。我们观察到中断前平均每月培训人数有所减少（-235，<0.001），中断后1个月减少幅度更大，为93.2%（-846，=0.013），中断后12个月有所增加（+217，<0.001）。中断后1个月职业应对者人数显著减少，中断后12个月非专业应对者人数显著增加。
研究结果表明，居家令发布后纳洛酮培训学员人数显著减少，随后在居家令发布后的12个月内出现适度反弹。接受培训的职业应对者人数减少可能限制了纳洛酮的获取，但可能已被接受培训的非专业应对者人数增加所抵消。加强非专业和职业应对者之间的联系可以在公共卫生危机期间维持纳洛酮的分发。
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