University of California Irvine, School of Medicine, Irvine, California.
University of California Irvine, School of Medicine, Department of Emergency Medicine, Irvine, California.
West J Emerg Med. 2024 Jul;25(4):500-506. doi: 10.5811/westjem.18037.
People who use drugs in community settings are at risk of a fatal overdose, which can be mitigated by naloxone administered via bystanders. In this study we sought to investigate methods of estimating and tracking opioid overdose reversals by community members with take-home naloxone (THN) to coalesce possible ways of characterizing THN reach with a metric that is useful for guiding both distribution of naloxone and advocacy of its benefits.
We conducted a scoping review of published literature on PubMed on August 15, 2022, using PRISMA-ScR protocol, for articles discussing methods to estimate THN reversals in the community. The following search terms were used: . We used backwards citation searching to potentially find additional studies. Overdose education and naloxone distribution program-based studies that analyzed only single programs were excluded.
The database search captured 614 studies, of which 14 studies were relevant. Backwards citation searching of 765 references did not reveal additional relevant studies. Of the 14 relevant studies, 11 were mathematical models. Ten used Markov models, and one used a system dynamics model. Of the remaining three articles, one was a meta-analysis, and two used spatial analysis. Studies ranged in year of publication from 2013-2022 with mathematical modeling increasing in use over time. Only spatial analysis was used with a focus on characterizing local naloxone use at the level of a specific city.
Of existing methods to estimate bystander administration of THN, mathematical models are most common, particularly Markov models. System dynamics modeling, meta-analysis, and spatial analysis have also been used. All methods are heavily dependent upon overdose education and naloxone distribution program data published in the literature or available as ongoing surveillance data. Overall, there is a paucity of literature describing methods of estimation and even fewer with methods applied to a local focus that would allow for more targeted distribution of naloxone.
在社区环境中使用毒品的人有致命药物过量的风险，可以通过旁观者给予纳洛酮来减轻。在这项研究中，我们试图调查社区中携带纳洛酮回家（THN）的人估计和跟踪阿片类药物过量逆转的方法，以聚合可能的方法来描述 THN 的覆盖范围，并使用对指导纳洛酮分布和宣传其益处有用的指标来进行特征描述。
我们于 2022 年 8 月 15 日在 PubMed 上使用 PRISMA-ScR 方案对已发表的文献进行了范围综述，以讨论在社区中估计 THN 逆转的方法。使用了以下搜索词：. 我们使用回溯引文搜索来寻找可能的其他研究。排除仅分析单一项目的基于过量用药教育和纳洛酮分发项目的研究。
数据库搜索捕获了 614 项研究，其中 14 项研究相关。对 765 篇参考文献的回溯引文搜索没有发现其他相关研究。在 14 项相关研究中，有 11 项是数学模型。其中 10 项使用马尔可夫模型，1 项使用系统动力学模型。其余 3 项研究中，1 项是荟萃分析，2 项使用空间分析。研究的发表年份从 2013 年到 2022 年不等，随着时间的推移，数学建模的使用越来越多。只有空间分析被用于描述特定城市特定级别的当地纳洛酮使用特征。
在估计旁观者给予 THN 的现有方法中，数学模型最常见，特别是马尔可夫模型。系统动力学建模、荟萃分析和空间分析也已被使用。所有方法都严重依赖于文献中发表的或作为正在进行的监测数据提供的过量用药教育和纳洛酮分发项目数据。总体而言，描述估计方法的文献很少，甚至更少的文献将方法应用于局部焦点，以便更有针对性地分发纳洛酮。
