The naloxone delivery cascade: Identifying disparities in access to naloxone among people who inject drugs in Los Angeles and San Francisco, CA
The naloxone delivery cascade: Identifying disparities in access to naloxone among people who inject drugs in Los Angeles and San Francisco, CA
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DOI：
10.1016/j.drugalcdep.2021.108759
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发表时间：
2021-05-28
影响因子：
4.2
通讯作者：
Lambdin, Barrot H.
中科院分区：
文献类型：
--
作者：
Kinnard, Elizabeth N.;Bluthenthal, Ricky N.;Lambdin, Barrot H.
背景：阿片类药物过量是美国伤害死亡的主要原因。为注射毒品者（PWID）提供纳洛酮对预防死亡至关重要。然而，关于纳洛酮给药缺口的研究有限。方法：我们于2017年至2018年在旧金山弗朗西斯科和洛杉矶，加州采访了536名PWID。我们描述了纳洛酮参与和再参与级联，并确定了与过去六个月接受纳洛酮和目前拥有纳洛酮相关的因素。结果如下：参与级联显示，72%的PWID曾经接受过纳洛酮，49%在过去六个月内接受过，35%目前拥有纳洛酮。再参与级联显示，在过去六个月内接受纳洛酮的PWID中，74%使用和/或失去纳洛酮，67%重新填充纳洛酮。在多变量分析中，标识为Latinx（aRR = 0.53; 95% CI：0.39，0.72）和黑人（aRR = 0.73; 95% CI：0.57，0.94）vs白色与过去6个月内接受纳洛酮呈负相关，而使用阿片类药物1-29次（aRR = 1.35; 95% CI：1.04，1.75）和30+倍（aRR = 1.52; 95% CI：1.17，1.99）vs过去30天内0次，过去6个月内目睹药物过量（aRR = 1.69; 95% CI：1.37，2.08）与过去6个月内接受纳洛酮治疗呈正相关。在多变量分析中，未圈养与圈养（aRR = 0.82; 95% CI：0.68，0.99）与目前拥有纳洛酮呈负相关。结论：我们的研究通过开发纳洛酮参与和重新参与级联来识别差异，从而增加了文献。扩大纳洛酮的规模应该让面临不公平获取的人群参与，包括有色人种和无家可归者。
Background: Opioid overdoses are a leading cause of injury death in the United States. Providing people who inject drugs (PWID) with naloxone is essential to preventing deaths. However, research regarding gaps in naloxone delivery is limited. Methods: We interviewed 536 PWID in San Francisco and Los Angeles, California from 2017 to 2018. We described naloxone engagement and re-engagement cascades, and identified factors associated with receiving naloxone in the past six months and currently owning naloxone. Results: The engagement cascade showed 72 % of PWID ever received naloxone, 49 % received it in the past six months, and 35 % currently owned naloxone. The re-engagement cascade showed, among PWID who received naloxone in the past six months, 74 % used and/or lost naloxone, and 67 % refilled naloxone. In multivariable analyses, identifying as Latinx (aRR = 0.53; 95 % CI: 0.39, 0.72) and Black (aRR = 0.73; 95 % CI: 0.57, 0.94) vs White were negatively associated with receiving naloxone in the past six months, while using opioids 1-29 times (aRR = 1.35; 95 % CI: 1.04, 1.75) and 30+ times (aRR = 1.52; 95 % CI: 1.17, 1.99) vs zero times in the past 30 days and witnessing an overdose in the past six months (aRR = 1.69; 95 % CI: 1.37, 2.08) were positively associated with receiving naloxone in the past six months. In multivariable analyses, being unhoused vs housed (aRR = 0.82; 95 % CI: 0.68, 0.99) was negatively associated with currently owning naloxone. Conclusions: Our study adds to the literature by developing naloxone engagement and re-engagement cascades to identify disparities. Naloxone scale-up should engage populations facing inequitable access, including people of color and those experiencing homelessness.