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

药房纳洛酮分布：评估降低用药过量死亡率的新工具

• 批准号: 9113804
• 负责人: Robin A Pollini
• 金额: $ 66.17万
• 依托单位: PACIFIC INSTITUTE FOR RES AND EVALUATION
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9113804
• 关键词: Accounting; Address; Adult; Analgesics; Cessation of life; Communities; Community Pharmacy; Country; Drug Controls; Drug Prescriptions; Emergency Situation; Ensure; Family member; Friends; Health; Health Personnel; Heroin; Individual; Injury; Interdisciplinary Study; Licensing; Life; Massachusetts; Methods; Modeling; Naloxone; Names; Narcotic Antagonists; Natural experiment; Opioid; Overdose; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Physicians; Poisoning; Policies; Private Sector; Public Health; Public Sector; Research; Research Design; Rhode Island; Risk; Site; Statutes and Laws; Training; United States; Vehicle crash; aged; base; community organizations; cost effective; design; emergency service responder; innovation; mortality; non-drug; novel; overdose death; overdose prevention; prescription pain reliever; programs; public health intervention; public health relevance; response; therapy design; tool; willingness

 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.

 描述（由申请人提供）：药物过量是美国 25 至 64 岁成年人受伤死亡的主要原因。 1999 年至 2013 年间，涉及阿片类止痛药的致命过量用药数量几乎增加了四倍，而 2010 年至 2013 年间，与海洛因相关的致命过量用药几乎增加了两倍。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“逆转”阿片类药物过量。增加纳洛酮的获取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，马萨诸塞州制定了一项创新计划，允许在社区药房发放纳洛酮常规订单 (NSO)。根据 NSO，药房可以向任何有或目睹阿片类药物过量风险的个人分发纳洛酮。马萨诸塞州是首批大规模实施基于药房的纳洛酮分配计划的州之一，但越来越多的州正在通过立法来授权这些计划。因此，马萨诸塞州代表着一项重要而及时的“自然实验”，旨在通过社区药房扩大纳洛酮的获取。本研究将采用多阶段混合方法研究设计来评估马萨诸塞州国家统计局计划的实施和影响。具体来说，本研究将 (1) 描述马萨诸塞州 NSO 计划的实施情况，并评估药房参与和正确配药的障碍和促进因素； (2) 检查非法阿片类药物使用者和潜在过量用药旁观者对基于药房的纳洛酮配药的可接受性，并确定可提高这两类人群接受度的因素； (3) 评估药房 NSO 计划对用药过量死亡率的影响。在我们的研究结束时，我们将对影响美国第一个全州药房纳洛酮配药计划的实施和影响的因素有一个全面的了解。我们的研究结果对于越来越多考虑和/或实施 NSO 计划作为其总体战略的一部分的国家具有相当大的价值，以减少阿片类药物过量死亡率的公共卫生负担。