Pharmacy Naloxone Distribution: Assessing a New Tool to Reduce Overdose Mortality

 描述(申请人提供)：吸毒过量是美国25岁至岁成年人伤害死亡的主要原因。1999年至2013年，涉及阿片类止痛药的致命过量数量几乎翻了两番，与海洛因有关的致命过量数量在2010年至2013年期间几乎翻了两番。迫切需要旨在减少阿片类药物过量死亡的公共卫生干预措施。纳洛酮是一种阿片类拮抗剂，可以“逆转”阿片类药物过量。更多地获得纳洛酮已被证明可以降低阿片类药物过量死亡率；然而，纳洛酮是一种处方药，这限制了扩大其分销的机会。2014年3月，马萨诸塞州建立了一项创新计划，允许在社区药店发布纳洛酮常规订单(NSO)。根据NSO，药店可以向任何有可能服用或目睹阿片类药物过量的个人分发纳洛酮。马萨诸塞州是首批大规模实施基于药房的纳洛酮分销计划的州之一，但越来越多的州正在通过立法授权这些计划。因此，马萨诸塞州是通过社区药店扩大纳洛酮使用范围的重要和及时的“自然实验”。这项研究将使用多阶段混合方法研究设计来评估马萨诸塞州NSO计划的实施和影响。具体地说，这项研究将(1)描述马萨诸塞州NSO计划的实施情况，并评估药房参与和适当分发的障碍和促进者；(2)检查非法阿片类药物使用者和潜在的过量旁观者对以药房为基础的纳洛酮分发的可接受性，并确定提高这两个群体接受程度的因素；以及(3)评估药房NSO计划对过量死亡率的影响。在我们的研究结束时，我们将对影响美国首批以药房为基础的纳洛酮处方计划之一的实施和影响的因素有一个全面的了解。我们的发现将对越来越多的州来说具有相当大的价值，这些州正在考虑和/或实施NSO计划，作为其总体战略的一部分，以减少阿片类药物过量死亡造成的公共健康负担。

 DESCRIPTION (provided by applicant): Drug overdose is the leading cause of injury death among adults aged 25 to 64 years in the United States. The number of fatal overdoses involving opioid pain relievers nearly quadrupled between 1999 and 2013, and fatal overdoses related to heroin almost tripled between 2010 and 2013. Public health interventions designed to reduce opioid overdose deaths are urgently needed. Naloxone is an opioid antagonist that "reverses" opioid overdoses. Increased access to naloxone has been shown to reduce opioid overdose mortality; however, naloxone is a prescription drug, which limits opportunities to expand its distribution. In March 2014, Massachusetts established an innovative program that allows the issuance of naloxone standing orders (NSO) at community pharmacies. Under NSO, pharmacies can dispense naloxone to any individual at risk of having, or witnessing, an opioid overdose. Massachusetts is one of the first states to implement a pharmacy-based naloxone distribution program on a broad scale, but a growing number of states are passing legislation to authorize these programs. Accordingly, Massachusetts represents an important and timely "natural experiment" in expanding naloxone access through community pharmacies. This study will use a multiphase mixed methods research design to assess the implementation and impact of the Massachusetts NSO program. Specifically, this study will (1) characterize implementation of the Massachusetts NSO program and assess barriers and facilitators to pharmacy participation and proper dispensing; (2) examine the acceptability of pharmacy-based naloxone dispensing to illicit opioid users and potential overdose bystanders and identify factors that would increase acceptance for these two groups; and (3) assess the impact of the pharmacy NSO program on overdose mortality. At the conclusion of our study, we will have generated a comprehensive understanding of the factors that influence the implementation and impact of one of the first statewide pharmacy-based naloxone dispensing programs in the United States. Our findings will be of considerable value to the growing number of states considering and/or implementing NSO programs as part of their overall strategy to reduce the public health burden of opioid overdose mortality.