Leung K H Benjamin, Grunau Brian E, Lee May K, Buxton Jane A, Helmer Jennie, van Diepen Sean, Christenson Jim, Chan Timothy C Y
Department of Mechanical & Industrial Engineering (Leung, Chan), University of Toronto, Toronto, Ont.; Duke Clinical Research Institute (Leung), Duke University, Durham, NC; Department of Emergency Medicine (Grunau, Christenson), University of British Columbia; Centre for Advancing Health Outcomes (Grunau, Lee, Christenson), St. Paul's Hospital; School of Population and Public Health (Buxton, Helmer), University of British Columbia; British Columbia Emergency Health Services (Helmer), Vancouver, BC; Division of Cardiology (van Diepen), Department of Medicine, and Department of Critical Care Medicine (van Diepen), University of Alberta, Edmonton, Alta.; Li Ka Shing Knowledge Institute (Chan), St. Michael's Hospital, Toronto, Ont.
CMAJ. 2025 Mar 16;197(10):E258-E265. doi: 10.1503/cmaj.241228.
More than 85 000 people die annually across North America from opioid poisoning; naloxone in the hands of the public is an effective intervention and saves lives. We compared the accessibility of different placement strategies for public-access naloxone kits.
We evaluated all opioid-poisoning incidents recorded by BC Emergency Health Services between December 2014 and August 2020 in Metro Vancouver, Canada. We determined the number of opioid poisonings "covered" (i.e., within a 3-minute walk) by 3 different coverage strategies: (1) existing locations participating in take-home naloxone programs; (2) blanket naloxone kit placement at chain businesses, pharmacies, and registered public-defibrillator locations; and (3) optimization-based strategic kit placement at transit stops based on historical poisonings.
We included 14 089 opioid poisonings. Existing locations participating in take-home naloxone programs (647 locations) covered 4988 (35.4%) opioid poisonings. Chain businesses (10-233 locations) covered 6 (0.0%) to 1165 (8.3%) opioid poisonings, and chain business categories (12-810 locations), pharmacies (790 locations), and public-defibrillator locations (980 locations) covered 97 (0.7%) to 3152 (22.4%) opioid poisonings. Optimization-based strategic placement of naloxone kits at transit stops yielded generally higher coverage levels, ranging from 2907 (20.6%) opioid poisonings covered with 10 kit locations, to 7506 (53.3%) with 1000 kit locations.
Optimized placement of publicly accessible naloxone kits at transit locations was most effective at improving public accessibility of naloxone, and blanket placement at take-home naloxone program locations covered a substantial proportion of opioid poisonings. Public-access naloxone may improve community access to naloxone in response to opioid poisonings.
在北美，每年有超过85000人死于阿片类药物中毒；公众手中的纳洛酮是一种有效的干预措施，可挽救生命。我们比较了公共获取纳洛酮试剂盒不同放置策略的可及性。
我们评估了2014年12月至2020年8月期间加拿大卑诗省紧急医疗服务机构记录的大温哥华地区所有阿片类药物中毒事件。我们确定了3种不同覆盖策略“覆盖”（即步行3分钟内）的阿片类药物中毒事件数量：（1）参与纳洛酮带回家计划的现有地点；（2）在连锁企业、药店和注册公共除颤器地点全面放置纳洛酮试剂盒；（3）根据历史中毒情况在公交站点进行基于优化的纳洛酮试剂盒策略性放置。
我们纳入了14089例阿片类药物中毒事件。参与纳洛酮带回家计划的现有地点（647个）覆盖了4988例（35.4%）阿片类药物中毒事件。连锁企业（10至233个地点）覆盖了6例（0.0%）至1165例（8.3%）阿片类药物中毒事件，连锁企业类别（12至810个地点）、药店（790个地点）和公共除颤器地点（980个地点）覆盖了97例（0.7%）至3152例（22.4%）阿片类药物中毒事件。在公交站点基于优化的纳洛酮试剂盒策略性放置通常能产生更高的覆盖水平，从10个试剂盒放置地点覆盖2907例（20.6%）阿片类药物中毒事件，到1000个试剂盒放置地点覆盖7506例（53.3%）。
在公交站点优化放置可公开获取的纳洛酮试剂盒在提高纳洛酮的公众可及性方面最为有效，在纳洛酮带回家计划地点全面放置覆盖了相当比例的阿片类药物中毒事件。可公开获取的纳洛酮可能会改善社区在应对阿片类药物中毒时获取纳洛酮的情况。
