Effectiveness and implementability of state-level naloxone access policies: Expert consensus from an online modified-Delphi process.
Effectiveness and implementability of state-level naloxone access policies: Expert consensus from an online modified-Delphi process.
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DOI：
10.1016/j.drugpo.2021.103383
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Grant S
中科院分区：
文献类型：
--
作者：
Smart R;Grant S
Naloxone distribution, a key global strategy to prevent fatal opioid overdose, has been a recent target of legislation in the U.S., but there is insufficient empirical evidence from causal inference methods to identify which components of these policies successfully reduce opioid-related harms. This study aimed to examine expert consensus on the effectiveness and implementability of various state-level naloxone policies. We used the online ExpertLens platform to conduct a three-round modified-Delphi process with a purposive sample of 46 key stakeholders (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with naloxone policy expertise. The Effectiveness Panel (n=24) rated average effects of 15 types of policies on naloxone pharmacy distribution, opioid use disorder (OUD) prevalence, nonfatal opioid-related overdoses, and opioid-related overdose mortality. The Implementation Panel (n=22) rated the same policies on acceptability, feasibility, affordability, and equitability. We compared ratings across policies using medians and inter-percentile ranges, with consensus measured using the RAND/UCLA Appropriateness Method Inter-Percentile Range Adjusted for Symmetry technique. Experts reached consensus on all items. Except for liability protections and required provision of education or training, experts perceived all policies to generate moderate-to-large increases in naloxone pharmacy distribution. However, only three policies were expected to yield substantive decreases on fatal overdose: statewide standing/protocol order, over-the-counter supply, and statewide “free naloxone.” Of these, experts rated only statewide standing/protocol orders as highly affordable and equitable, and unlikely to generate meaningful population-level effects on OUD or nonfatal opioid-related overdose. Across all policies, experts rated naloxone prescribing mandates relatively lower in acceptability, feasibility, affordability, and equitability. Experts believe statewide standing/protocol orders are an effective, implementable, and equitable policy for addressing opioid-related overdose mortality. While experts believe many other broad policies are effective in reducing opioid-related harms, they also believe these policies face implementation challenges related to cost and reaching vulnerable populations.
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DOI：
10.1111/add.13265
发表时间：
2016-05
期刊：
Addiction (Abingdon, England)
影响因子：
--
作者：
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通讯作者：
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10.1007/s11121-016-0653-4
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2016-08
期刊：
Prevention science : the official journal of the Society for Prevention Research
影响因子：
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10.1007/s11524-020-00439-5
发表时间：
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