More than just availability: Who has access and who administers take-home naloxone in Baltimore, MD
More than just availability: Who has access and who administers take-home naloxone in Baltimore, MD
复制标题
DOI：
10.1371/journal.pone.0224686
复制
发表时间：
2019-11-07
期刊：
影响因子：
3.7
通讯作者：
Latkin, Carl
中科院分区：
文献类型：
--
作者：
Dayton, Lauren;Gicquelais, Rachel E.;Latkin, Carl
在美国，致命的阿片类药物过量是一个紧迫的公共卫生问题。解决障碍和增加促进者带回家纳洛酮（THN）的访问和管理可以扩大计划范围，防止致命的过量。在马里兰州巴尔的摩对577名使用阿片类药物（PWUO）并有注射毒品史的人进行了评估。一项子分析研究了THN使用者和目睹过量者（N = 345）中THN给药的相关性。Logistic广义估计方程与强大的标准误，以确定促进者和障碍访问和使用THN.ResultsThe大多数PWUO（66%）报告THN访问。在多变量模型中，减少THN接入与担心一个人在用THN复活后可能变得具有攻击性有关（aOR：0.55，95% CI：0.35-0.85），警察在过量事件中威胁人们（aOR：0.68，95% CI：0.36-1.00）和过量训练不足（aOR：0.43，95% CI：0.28-0.68）。参加药物辅助治疗，个人经历过量，高中毕业与更高的访问相关。大约一半（49%）的PWUO与THN访问和谁目睹了过量报告管理THN。THN使用与“经常”或“总是”携带THN（aOR：3.47，95%CI：1.99-6.06），目睹更多过量（aOR：5.18，95%CI：2.22-12.07），最近无家可归，以及在过去一年注射呈正相关。THN使用减少参与者谁不觉得他们有足够的过量训练（aOR：0.56，95%CI：0.32-0.96）。ConclusionTHN程序必须加强管理THN的信心，并解决使用障碍，如恐惧的THN收件人变得咄咄逼人。围绕携带THN的规范性变化是过量预防策略的重要组成部分。
BackgroundFatal opioid overdose is a pressing public health concern in the United States. Addressing barriers and augmenting facilitators to take-home naloxone (THN) access and administration could expand program reach in preventing fatal overdoses.MethodsTHN access (i.e., being prescribed or receiving THN) was assessed in a Baltimore, Maryland-based sample of 577 people who use opioids (PWUO) and had a history of injecting drugs. A sub-analysis examined correlates of THN administration among those with THN access and who witnessed an overdose (N = 345). Logistic generalized estimating equations with robust standard errors were used to identify facilitators and barriers to accessing and using THN.ResultsThe majority of PWUO (66%) reported THN access. In the multivariable model, decreased THN access was associated with the fear that a person may become aggressive after being revived with THN (aOR: 0.55, 95% CI: 0.35-0.85), police threaten people at an overdose event (aOR: 0.68, 95% CI: 0.36-1.00), and insufficient overdose training (aOR: 0.43, 95% CI: 0.28-0.68). Enrollment in medication-assisted treatment, personally experiencing an overdose, and graduating from high school were associated with higher access. About half (49%) of PWUO with THN access and who had witnessed an overdose reported having administered THN. THN use was positively associated with "often" or "always" carrying THN (aOR: 3.47, 95% CI: 1.99-6.06), witnessing more overdoses (aOR:5.18, 95% CI: 2.22-12.07), experiencing recent homelessness, and injecting in the past year. THN use was reduced among participants who did not feel that they had sufficient overdose training (aOR: 0.56, 95% CI: 0.32-0.96).ConclusionTHN programs must bolster confidence in administering THN and address barriers to use, such as fear of a THN recipient becoming aggressive. Normative change around carrying THN is an important component in an overdose prevention strategy.