Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use: Evidence from 44 US states.
Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use: Evidence from 44 US states.
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纳洛酮的扩张与青少年海洛因使用和注射毒品使用的增加无关：来自美国 44 个州的证据。
DOI：
10.1016/j.drugpo.2023.103980
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Martins,SilviaS
中科院分区：
文献类型：
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作者：
Bruzelius,Emilie;Cerdá,Magdalena;Davis,CoreyS;Jent,Victoria;Wheeler-Martin,Katherine;Mauro,ChristineM;Crystal,Stephen;Keyes,KatherineM;Samples,Hillary;Hasin,DeborahS;Martins,SilviaS
背景纳洛酮的分配是解决阿片类药物过量危机的持续努力的核心。一些批评人士认为，纳洛酮的扩张可能会无意中促进青少年的高危物质使用行为，但这个问题尚未得到直接调查。方法我们考察了2007-2019年纳洛酮获取法和药房纳洛酮分配与终生海洛因和注射毒品使用(IDU)的关系。产生调整的优势比(AOR)和95%可信区间(CI)的模型包括年份和国家固定效应，对阿片类药物环境中的人口统计和变异来源(例如，芬太尼渗透)进行了控制，以及预计将影响药物使用的额外政策(例如，处方药监测)。探索性和敏感性分析进一步检查了纳洛酮法律条款(例如，第三方处方)，并应用e-Value测试来评估对未测量的混杂的易感性。结果采用任何纳洛酮法律与青少年终生海洛因或注射毒品的变化无关。在药房配药方面，我们观察到海洛因使用量略有下降(AOR：0.95[CI：0.92，0.99])，注射毒品使用量略有增加(AOR：1.07[CI：1.02，1.11])。对法律条款的探索性分析表明，第三方处方(AOR：0.80，[CI：0.66，0.96])和非患者专用配药模式(AOR：0.78，[CI：0.61，0.99])与海洛因使用量的减少有关，但与IDU的减少无关。与药房配药和供应估计相关的较小的e值表明，未测量的混淆可以解释观察到的发现。结论纳洛酮准入规则和药房纳洛酮分布更一致地与青少年终生海洛因和静脉吸毒的减少有关，而不是增加。因此，我们的发现不支持纳洛酮促进高危青少年药物使用行为的担忧。截至2019年，美国所有州都通过了立法，以改善纳洛酮的获取和便利使用。然而，鉴于阿片类药物的流行继续影响所有年龄段的人，进一步消除青少年纳洛酮使用障碍是一个重要的优先事项。
BackgroundNaloxone distribution is central to ongoing efforts to address the opioid overdose crisis. Some critics contend that naloxone expansion may inadvertently promote high-risk substance use behaviors among adolescents, but this question has not been directly investigated.MethodsWe examined relationships between naloxone access laws and pharmacy naloxone distribution with lifetime heroin and injection drug use (IDU), 2007-2019. Models generating adjusted odds ratios (aOR) and 95% confidence intervals (CI) included year and state fixed effects, controlled for demographics and sources of variation in opioid environments (e.g., fentanyl penetration), as well as additional policies expected to impact substance use (e.g., prescription drug monitoring). Exploratory and sensitivity analyses further examined naloxone law provisions (e.g., third-party prescribing) and applied e-value testing to assess vulnerability to unmeasured confounding.ResultsAdoption of any naloxone law was not associated with changes in adolescent lifetime heroin or IDU. For pharmacy dispensing, we observed a small decrease in heroin use (aOR: 0.95 [CI: 0.92, 0.99]) and a small increase in IDU (aOR: 1.07 [CI: 1.02, 1.11]). Exploratory analyses of law provisions suggested that third-party prescribing (aOR: 0.80, [CI: 0.66, 0.96]) and non-patient-specific dispensing models (aOR: 0.78, [CI: 0.61, 0.99]) were associated with decreased heroin use but not decreased IDU. Small e-values associated with the pharmacy dispensing and provision estimates indicate that unmeasured confounding may explain observed findings.ConclusionNaloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages