Geographic variation in the provision of naloxone by pharmacies in Ontario, Canada: A population-based small area variation analysis
| Autor: | Tara Gomes, Tony Antoniou, Pamela Leece, Rinku Sutradhar, Tonya Campbell, Daniel McCormack, Nancy Lum-Wilson, Mina Tadrous, Charlotte Munro |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Narcotic Antagonists Population Toxicology Rate ratio 03 medical and health sciences 0302 clinical medicine Harm Reduction Naloxone medicine Opiate Substitution Treatment Humans Pharmacology (medical) 030212 general & internal medicine education Pharmacology Ontario Pharmacies Harm reduction education.field_of_study business.industry Public health Opioid overdose Opioid use disorder Middle Aged medicine.disease Opioid-Related Disorders Confidence interval 3. Good health Analgesics Opioid Psychiatry and Mental health Pharmaceutical Services Small-Area Analysis Female Drug Overdose business 030217 neurology & neurosurgery medicine.drug Demography |
| Zdroj: | Drug and alcohol dependence. 216 |
| ISSN: | 1879-0046 |
| Popis: | Background Regional variation in pharmacy-dispensed naloxone rates could create access disparities that undermine the effectiveness of this approach. We explored individual and public health unit (PHU)-level determinants of regional variation in naloxone distribution through the Ontario Naloxone Program for Pharmacies. Methods We conducted a population-based study between April 1, 2017 and March 31, 2018. We calculated age- and sex-standardized pharmacy-dispensed naloxone rates for the 35 Ontario PHUs, and identified determinants of these rates using generalized estimating equations negative binomial regression. Results The age- and sex-standardized pharmacy-dispensed naloxone rate in Ontario was 5.5 (range 1.8–11.6) kits per 1000 population. Variables associated with higher naloxone dispensing rates included opioid use disorder history [rate ratio (RR) 2.27; 95% confidence interval (CI) 1.75–2.96], opioid agonist therapy (RR 11.17; 95% CI 7.15–17.44), and PHU opioid overdose rate (RR 1.09 per 10 deaths; 95% CI 1.06–1.13). Pharmacy-dispensed naloxone rates were lower in rural areas (RR 0.83; 95% CI 0.73–0.94) and among individuals dispensed one (RR 0.72; 95% CI 0.65–0.79), two to five (RR 0.67; 95% CI 0.54–0.84) or 6–10 (RR 0.92; 95% CI 0.74–1.14) opioids in the prior year relative to those receiving no opioids. Conclusion Pharmacy-dispensed naloxone programs are important components of a public health response to the opioid overdose crisis. We found considerable variation in pharmacy-dispensed naloxone rates that could limit program effectiveness, particularly in rural settings with limited access to health and harm reduction services.. |
| Databáze: | OpenAIRE |
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