Evaluation of Strategies to Enhance Community-Based Naloxone Distribution Supported by an Opioid Settlement.

Autor:	Zang X; Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis., Skinner A; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island., Krieger MS; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island., Behrends CN; Department of Population Health Sciences, Weill Cornell Medical College, New York City, New York., Park JN; Department of Medicine, Brown University, Providence, Rhode Island., Green TC; The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts., Walley AY; Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts., Morgan JR; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts., Linas BP; Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts.; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts., Yedinak JL; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island., Schackman BR; Department of Population Health Sciences, Weill Cornell Medical College, New York City, New York., Marshall BDL; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 May 01; Vol. 7 (5), pp. e2413861. Date of Electronic Publication: 2024 May 01.
DOI:	10.1001/jamanetworkopen.2024.13861
Abstrakt:	Importance: Many US states are substantially increasing community-based naloxone distribution, supported in part through settlements from opioid manufacturers and distributors. Objectives: To evaluate the potential impact of increased naloxone availability on opioid overdose deaths (OODs) and explore strategies to enhance this impact by integrating interventions to address solitary drug use. Design, Setting, and Participants: This decision analytical modeling study used PROFOUND (Prevention and Rescue of Fentanyl and Other Opioid Overdoses Using Optimized Naloxone Distribution Strategies), a previously published simulation model, to forecast annual OODs between January 2023 and December 2025. The simulated study population included individuals from Rhode Island who misused opioids and stimulants and were at risk for opioid overdose. Exposures: The study modeled expanded naloxone distribution supported by the state's opioid settlement (50 000 naloxone nasal spray kits each year). Two approaches to expanding naloxone distribution were evaluated: one based on historical spatial patterns of naloxone distribution (supply-based approach) and one based on the spatial distribution of individuals at risk (demand-based approach). In addition, hypothetical interventions to enhance the likelihood of witnessed overdoses in private or semiprivate settings were considered. Main Outcomes and Measures: Annual number of OODs and ratio of fatal to nonfatal opioid overdoses. Results: Modeling results indicated that distributing more naloxone supported by the state's opioid settlement could reduce OODs by 6.3% (95% simulation interval [SI], 0.3%-13.7%) and 8.8% (95% SI, 1.8%-17.5%) in 2025 with the supply-based and demand-based approaches, respectively. However, increasing witnessed overdoses by 20% to 60% demonstrated greater potential for reducing OODs, ranging from 8.5% (95% SI, 0.0%-20.3%) to 24.1% (95% SI, 8.6%-39.3%). Notably, synergistic associations were observed when combining both interventions: increased naloxone distribution with the 2 approaches and a 60% increase in witnessed overdoses could reduce OODs in 2025 by 33.5% (95% SI, 17.1%-50.4%) and 37.4% (95% SI, 19.6%-56.3%), respectively. Conclusions and Relevance: These findings suggest that interventions to address solitary drug use are needed to maximize the impact of continued efforts to increase community-based naloxone distribution, which may be particularly important for jurisdictions that have strong community-based naloxone distribution programs.
Databáze:	MEDLINE
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