Rangachari Pavani, Tran Alvin
Department of Population Health and Leadership, University of New Haven, West Haven, CT, USA.
Risk Manag Healthc Policy. 2025 Jun 14;18:1935-1946. doi: 10.2147/RMHP.S521720. eCollection 2025.
The opioid crisis in the United States remains a major public health emergency, claiming over 100,000 lives annually, with potent synthetic opioids like fentanyl driving the surge in overdose deaths. In response, the US Food and Drug Administration's (FDA) approval of over-the-counter (OTC) Narcan represents a pivotal step toward expanding access to naloxone, a life-saving medication that reverses opioid overdoses. However, maximizing the public health impact of this measure requires more than increasing availability-it demands a comprehensive, systemic approach that fosters community engagement, advances harm reduction, and transforms healthcare delivery. This paper applies the Robert Wood Johnson Foundation's (RWJF) Culture of Health (COH) model to provide a structured framework for optimizing Narcan's impact. Through its four interconnected pillars, (1) making health a shared value, (2) fostering cross-sector collaboration, (3) ensuring equitable access, and (4) transforming healthcare systems, the COH model offers critical insights into building sustainable, community-wide overdose prevention strategies. Central to this effort is stigma reduction, as negative perceptions of opioid use disorder continue to undermine both public willingness to seek naloxone and healthcare providers' readiness to offer it. Within the COH framework, the paper examines evidence-based interventions that normalize naloxone use, innovative cross-sector partnerships that foster acceptance, and policy initiatives that expand access while addressing systemic inequities. By synthesizing real-world success stories, including community-based naloxone distribution programs, law enforcement-assisted interventions, and hospital-based harm reduction initiatives, this paper outlines a strategic blueprint for translating the FDA's Narcan ruling into lasting public health outcomes. It concludes with actionable recommendations for healthcare systems, policymakers, and public health agencies to institutionalize harm reduction practices and dismantle barriers to care. Only by embedding a Culture of Health into the fabric of healthcare, public health, and community systems can we achieve lasting progress against the opioid crisis and foster healthier, more equitable communities.
美国的阿片类药物危机仍然是一项重大的公共卫生紧急事件，每年导致超过10万人死亡，强效合成阿片类药物如芬太尼推动了过量用药死亡人数的激增。作为回应，美国食品药品监督管理局（FDA）批准非处方（OTC）纳洛酮是朝着扩大纳洛酮可及性迈出的关键一步，纳洛酮是一种能逆转阿片类药物过量的救命药物。然而，要使这一措施对公共卫生产生最大影响，不仅需要增加其可及性，还需要一种全面、系统的方法，促进社区参与，推进减少伤害，并转变医疗服务提供方式。本文应用罗伯特·伍德·约翰逊基金会（RWJF）的健康文化（COH）模型，为优化纳洛酮的影响提供一个结构化框架。通过其四个相互关联的支柱，即（1）使健康成为共享价值，（2）促进跨部门合作，（3）确保公平可及，以及（4）转变医疗系统，COH模型为构建可持续的、全社区范围的过量用药预防策略提供了关键见解。这项工作的核心是减少污名化，因为对阿片类药物使用障碍的负面看法继续削弱公众寻求纳洛酮的意愿以及医疗服务提供者提供纳洛酮的意愿。在COH框架内，本文研究了使纳洛酮使用常态化的循证干预措施、促进接受度的创新跨部门伙伴关系，以及在解决系统性不平等问题的同时扩大可及性的政策举措。通过综合现实世界的成功案例，包括基于社区的纳洛酮分发项目、执法辅助干预措施以及基于医院的减少伤害举措，本文勾勒出了将FDA的纳洛酮裁决转化为持久公共卫生成果的战略蓝图。文章最后为医疗系统、政策制定者和公共卫生机构提出了可操作的建议，以将减少伤害做法制度化并消除护理障碍。只有将健康文化融入医疗、公共卫生和社区系统的结构中，我们才能在应对阿片类药物危机方面取得持久进展，并培育更健康、更公平的社区。
