Improving Naloxone Access and Its Effects on Drug Abuse and Overdoses

项目总结/摘要 1999年至2010年期间，阿片类药物过量急剧增加。2010年， 死亡是由处方阿片类药物过量引起的，占所有药物的近60%。 过量死亡，以及海洛因和可卡因合并过量死亡。最近 处方阿片类药物死亡率的适度下降伴随着 海洛因滥用2014年，有超过13，000人死于海洛因。针对这些 为了应对这一趋势，已经采取了许多联邦和州政策来遏制吸毒过量率。 通过政策改善纳洛酮的可及性特别有希望，因为众所周知纳洛酮 有效逆转阿片类药物的致命作用。然而，直到最近， 纳洛酮的分销网络相当有限，随后是最近的一波政策 改革的动机是改善纳洛酮的获得。政策鼓励增加 纳洛酮的使用和随后减少过量通常是未知的。 在这个项目中，我们建议研究国家政策改善纳洛酮获得的能力 并了解哪类政策（如果有的话）最有效。我们有初步的 有证据表明，允许处方医生根据自己的权限分配纳洛酮对于 增加纳洛酮处方。我们还将特别重视以下方面的反应： 私人药房到国家政策，使纳洛酮在没有病人的情况下合法化， 具体处方。大型连锁药店已经制定了自己的私人政策， 纳洛酮的使用，这些政策随着时间的推移在几个州蔓延。的影响 这些私人政策的影响应根据地理位置而有所不同，这些链的渗透， 不同的社区。我们将研究私人药房政策是否可以改善获得， 在国家政策之外减少过量用药。 我们将使用各种丰富的数据集来衡量我们的成果。我们将使用 2010-2017年关于纳洛酮配药的全面季度邮政编码级数据。我们将 还收集关于药房位置以及关于纳洛酮的药房级政策的数据 配药。我们将探讨哪些类型的国家政策改善纳洛酮的获得和作用， 药房政策。随后，我们将测试改善纳洛酮的使用是否会影响致命的 过量和非致命性过量 这个项目将提出一些纳洛酮的有效性的第一个证据 政策的纳洛酮处方，同时也探索机制，使这种政策 在配药和减少过量方面最有效。

Project Summary/Abstract Opioid overdoses increased dramatically between 1999 and 2010. In 2010, 16,651 deaths were caused by a prescription opioid overdose, representing nearly 60% of all drug overdose deaths, and exceeding overdose deaths from heroin and cocaine combined. Recent modest declines in prescription opioid mortality rates have been paired with large increases in heroin abuse. In 2014, there were over 13,000 deaths involving heroin. In response to these trends, numerous federal and state policies have been adopted to curb the overdose rate. Improving access to naloxone through policy is especially promising as naloxone is known to be effective in reversing the life-threatening effects of opioids. Until relatively recently, however, naloxone has had a rather limited distribution network, followed by a recent wave of policy reforms motivated to improve naloxone access. The ability of policy to encourage additional naloxone access and subsequently reduce overdoses is generally unknown. In this project, we propose to study the ability of state policy to improve naloxone access and to understand which types of policies, if any, do so most effectively. We have preliminary evidence that permitting prescribers to dispense naloxone under their own authority is crucial for increasing naloxone prescribing. We will also place special emphasis on the responses of private pharmacies to state policies which legalize dispensing of naloxone without a patient- specific prescription. Large pharmacy chains have enacted their own private policies to improve naloxone access, and these policies have spread over time across several states. The effects of these private policies should vary geographically based the penetration of these chains in different communities. We will study whether private pharmacy policy can improve access and reduce overdoses above and beyond state policy. We will use a variety of rich data sets to measure our outcomes. We will use comprehensive quarterly zip code-level data on naloxone dispensing for 2010-2017. We will also collect data on pharmacy locations as well as pharmacy-level policy concerning naloxone dispensing. We will explore what types of state policy improve naloxone access and the role of pharmacy policy. We will subsequently test whether improved naloxone access affects fatal overdoses and nonfatal overdoses This project will present some of the first evidence of the effectiveness of naloxone policy on naloxone prescriptions while also exploring the mechanisms which make such policies most effective in terms of dispensing and reducing overdoses.