CommunityStat: A Public Health Intervention to Reduce Opioid Overdose Deaths in Burlington, Vermont, 2017-2020.
CommunityStat: A Public Health Intervention to Reduce Opioid Overdose Deaths in Burlington, Vermont, 2017-2020.
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DOI：
10.1177/00914509211052107
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发表时间：
2022-03
影响因子：
--
通讯作者：
Del Pozo B
中科院分区：
文献类型：
--
作者：
Del Pozo B
从2017年到2020年初，美国佛蒙特州伯灵顿市领导了一项全县范围的努力，通过专注于阿片类药物使用障碍药物的广泛、低障碍分布，减少阿片类药物过量死亡。作为一个没有公共卫生人员的小城市，这项倡议是由警察局领导的——他们明白它不会以执法为导向——并以CompStat的地方改编为中心。CompStat是纽约市警察局开发的一项管理和问责计划，被认为既能改善公共安全，又过分强调如果不仔细指导，会适得其反的警察绩效指标。该倡议有助于实施几项新的干预措施：该市注射器服务方案的丁丙诺啡低门槛处方、在当地医院急诊科引入以丁丙诺啡为基础的治疗、消除阿片类药物使用障碍（mod）药物的区域等候名单，以及警察局长和县检察官事实上将转移的丁丙诺啡非刑事化。当地立法者的努力促成了一项州法律，要求为所有患有阿片类药物使用障碍的囚犯提供mod。到2018年底，这些干预措施共同使该县致命的过量死亡人数减少了50%(17比34)，而佛蒙特州其他地区的死亡人数增加了20%。这种减少一直持续到2019年底。本文描述了伯灵顿官员为实施这些干预措施所做的努力。它为其他城市提供了一个范例，只要利益攸关方同意在促进拯救生命的承诺方面进行持续合作，就可以采用循证方法减少阿片类药物死亡。在此过程中，报告强调，警察主导的公共卫生干预措施是例外，解决过量危机将需要改革，不再将刑事定罪作为一个社区对药物使用的默认框架。
From 2017 to early 2020, the US city of Burlington, Vermont led a county-wide effort to reduce opioid overdose deaths by concentrating on the widespread, low-barrier distribution of medications for opioid use disorder. As a small city without a public health staff, the initiative was led out of the police department—with an understanding that it would not be enforcement-oriented—and centered on a local adaptation of CompStat, a management and accountability program developed by the New York City Police Department that has been cited as both yielding improvements in public safety and overemphasizing counterproductive police performance metrics if not carefully directed. The initiative was instrumental to the implementation of several novel interventions: low-threshold buprenorphine prescribing at the city’s syringe service program, induction into buprenorphine-based treatment at the local hospital emergency department, elimination of the regional waiting list for medications for opioid use disorder (MOUD), and the de-facto decriminalization of diverted buprenorphine by the chief of police and county prosecutor. An effort by local legislators resulted in a state law requiring all inmates with opioid use disorder be provided with MOUD as well. By the end of 2018, these interventions were collectively associated with a 50% (17 vs. 34) reduction in the county’s fatal overdose deaths, while deaths increased 20% in the remainder of Vermont. The reduction was sustained through the end of 2019. This article describes the effort undertaken by officials in Burlington to implement these interventions. It provides an example that other municipalities can use to take an evidence-based approach to reducing opioid deaths, provided stakeholders assent to sustained collaboration in the furtherance of a commitment to save lives. In doing so, it highlights that police-led public health interventions are the exception, and addressing the overdose crisis will require reform that shifts away from criminalization as a community’s default framework for substance use.
影响因子：
2
作者：
Hunt G;Moloney M;Fazio A
通讯作者：
Fazio A