Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria.
Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria.
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DOI：
10.1111/add.13326
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发表时间：
2016-07
期刊：
影响因子：
--
通讯作者：
Strang J
中科院分区：
文献类型：
--
作者：
McDonald R;Strang J
一旦发现阿片类药物过量的致命后果，可通过及时给予解毒剂纳洛酮来预防。最近在全球超过15个国家实施了直接向阿片类药物使用者提供纳洛酮带回家供紧急使用的做法，尽管主要是作为试点计划，没有进行正式评价。本系统综述评估了带回家的纳洛酮的有效性，有两个具体目的：(1)研究带回家的纳洛酮分布对过量相关死亡率的影响；(2)从不良事件方面评估带回家的纳洛酮的安全性。使用布尔搜索查询（阿片类药物或阿片类药物）和过量和预防，检索PubMed， MEDLINE和PsychINFO的英文同行评审出版物（随机或观察性试验）。证据评估使用九条布拉德福德希尔标准的因果关系，设计用于评估公共卫生干预和临床结果之间的潜在因果关系，当只有观察数据可用。共检索了1397条记录（删除重复项后为1164条），其中22项观察性研究符合入选标准。由于纳入研究的规模和质量存在差异，meta分析被排除在外，转而采用叙事综合。从符合条件的研究中，我们发现带回家的纳洛酮符合布拉德福德希尔的所有九项标准。世界卫生组织的另外五项标准全部或部分（二）或完全（三）得到满足。即使服用纳洛酮带回家，123例服药过量病例中也有1例出现致命结果（0.8%；95%可信区间= 0.4,1.2）。研究发现，纳洛酮带回家方案可降低方案参与者和社区的过量死亡率，并具有较低的不良事件发生率。
Fatal outcome of opioid overdose, once detected, is preventable through timely administration of the antidote naloxone. Take‐home naloxone provision directly to opioid users for emergency use has been implemented recently in more than 15 countries worldwide, albeit mainly as pilot schemes and without formal evaluation. This systematic review assesses the effectiveness of take‐home naloxone, with two specific aims: (1) to study the impact of take‐home naloxone distribution on overdose‐related mortality; and (2) to assess the safety of take‐home naloxone in terms of adverse events. PubMed, MEDLINE and PsychINFO were searched for English‐language peer‐reviewed publications (randomized or observational trials) using the Boolean search query: (opioid OR opiate) AND overdose AND prevention. Evidence was evaluated using the nine Bradford Hill criteria for causation, devised to assess a potential causal relationship between public health interventions and clinical outcomes when only observational data are available. A total of 1397 records (1164 after removal of duplicates) were retrieved, with 22 observational studies meeting eligibility criteria. Due to variability in size and quality of the included studies, meta‐analysis was dismissed in favour of narrative synthesis. From eligible studies, we found take‐home naloxone met all nine Bradford Hill criteria. The additional five World Health Organization criteria were all either met partially (two) or fully (three). Even with take‐home naloxone administration, fatal outcome was reported in one in 123 overdose cases (0.8%; 95% confidence interval = 0.4, 1.2). Take‐home naloxone programmes are found to reduce overdose mortality among programme participants and in the community and have a low rate of adverse events.
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影响因子：
5.9
作者：
Lankenau, Stephen E.;Wagner, Karla D.;Kral, Alex H.
通讯作者：
Kral, Alex H.
影响因子：
4.4
作者：
Galea, Sandro;Worthington, Nancy;Rosenthal, David M.
通讯作者：
Rosenthal, David M.
DOI：
10.9778/cmajo.20140008
发表时间：
2014-07-01
期刊：
CMAJ open
影响因子：
--
作者：
Banjo, Oluwajenyo;Tzemis, Despina;Buxton, Jane A
通讯作者：
Buxton, Jane A
旧金山阿片类药物用户的预防过量预防和纳洛酮处方。
DOI：
10.1007/s11524-010-9495-8
发表时间：
2010-12
影响因子：
6.6
作者：
Enteen, Lauren;Bauer, Joanna;McLean, Rachel;Wheeler, Eliza;Huriaux, Emalie;Kral, Alex H.;Bamberger, Joshua D.
通讯作者：
Bamberger, Joshua D.
影响因子：
4.5
作者：
Doe-Simkins, Maya;Quinn, Emily;Walley, Alexander Y.
通讯作者：
Walley, Alexander Y.