Floyd Anthony S, Silcox Joseph, Strickler Gail, Nong Thuong, Blough Malcolm, Bolivar Derek, Rabin Megan, Bratberg Jeffrey, Irwin Adriane N, Hartung Daniel M, Hansen Ryan N, Bohler Robert, Green Traci C
Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA.
Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA.
Drug Alcohol Depend Rep. 2024 May 28;11:100243. doi: 10.1016/j.dadr.2024.100243. eCollection 2024 Jun.
As the US opioid-involved morbidity and mortality increase, uptake and implementation of evidence-based interventions remain key policy responses. Respond to Prevent was a multi-component, randomized trial implemented in four states and two large pharmacy chains with the aim of improving the pharmacy's capacity to provide naloxone, dispense buprenorphine, and sell nonprescription syringes (NPS). We sought to provide context and assess how policies and organizational practices affect communities and pharmacies across the study states.
Using a multi-method approach we: 1) conducted an environmental scan of published literature and online materials spanning January 2015 to June 2021, 2) created timelines of key events pertaining to those policies and practices and 3) conducted semi-structured interviews with stakeholders (key informants) at the state and local levels (N=36) to provide further context for the policies and practices we discovered.
Key informants discussed state policies, pharmacy policies and local practices that facilitated access to naloxone, buprenorphine and NPSs. Interviewees from all states spoke about the impact of naloxone standing orders, active partnerships with community-based harm reduction organizations, and some federal and state policies like Medicaid coverage for naloxone and buprenorphine, and buprenorphine telehealth permissions as key facilitators. They also discussed patient stigma, access in rural settings, and high cost of medications as barriers.
Findings underscore the important role harm reduction-related policies play in boosting and institutionalizing interventions in communities and pharmacies while also identifying structural barriers where more focused state and local attention is needed.
随着美国阿片类药物相关的发病率和死亡率上升，采用并实施循证干预措施仍然是关键的政策应对措施。“应对预防”是一项多组成部分的随机试验，在四个州和两家大型连锁药店开展，目的是提高药店提供纳洛酮、配发丁丙诺啡以及销售非处方注射器（NPS）的能力。我们试图提供背景信息，并评估政策和组织实践如何影响研究所在各州的社区和药店。
我们采用多方法途径：1）对2015年1月至2021年6月期间发表的文献和在线材料进行环境扫描，2）创建与这些政策和实践相关的关键事件时间表，3）对州和地方层面的利益相关者（关键信息提供者）进行半结构化访谈（N = 36），以便为我们发现的政策和实践提供更多背景信息。
关键信息提供者讨论了有助于获取纳洛酮、丁丙诺啡和非处方注射器的州政策、药店政策和地方实践。所有州的受访者都谈到了纳洛酮常备医嘱、与社区减少伤害组织的积极合作关系以及一些联邦和州政策（如纳洛酮和丁丙诺啡的医疗补助覆盖范围以及丁丙诺啡远程医疗许可）作为关键促进因素的影响。他们还讨论了患者的耻辱感、农村地区的获取问题以及药物的高成本作为障碍。
研究结果强调了与减少伤害相关的政策在促进社区和药店干预措施并使其制度化方面所起的重要作用，同时也确定了需要州和地方更多关注的结构性障碍。
