Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis.
Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis.
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DOI：
10.1136/bmj.f174
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发表时间：
2013-01-30
期刊：
影响因子：
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通讯作者：
Ozonoff A
中科院分区：
文献类型：
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作者：
Walley AY;Xuan Z;Hackman HH;Quinn E;Doe-Simkins M;Sorensen-Alawad A;Ruiz S;Ozonoff A
目的评价国家支持的过量教育和鼻纳洛酮分配（OEND）计划对马萨诸塞州阿片类药物过量相关死亡率和急性护理利用的影响。设计：对2002年至2009年阿片类药物过量死亡和急性护理利用率进行中断时间序列分析，比较OEND实施率高和低的社区年分层与未实施的社区年分层。设定19个马萨诸塞州社区（地理上不同的城市和城镇），在2004年至2006年期间每年至少有5个致命的阿片类药物过量。参与者OEND在有过量风险的阿片类药物使用者，社会服务机构工作人员，阿片类药物使用者的家人和朋友中实施。 干预OEND计划为有过量风险的人和旁观者配备了鼻纳洛酮急救包，并培训他们如何通过参与紧急医疗服务，提供救援呼吸和提供纳洛酮来预防，识别和应对过量。主要结局指标调整后的阿片类药物过量相关年度死亡率和急性护理医院利用率。结果在这些社区中，OEND项目培训了2912名潜在的旁观者，他们报告了327次救援。每10万人口中有1 - 100人注册的社区年分层（调整后比率为0.73，95%置信区间为0.57至0.91）和每10万人口中有超过100人注册的社区年分层（0.54，0.39至0.76）与未实施的社区相比，调整后比率显着降低。急性护理医院利用率的差异不显著。结论阿片类药物过量死亡率在实施OEND的社区降低。这项研究提供了观察证据，通过培训潜在的旁观者来预防，识别和应对阿片类药物过量，OEND是一种有效的干预措施。
Objective To evaluate the impact of state supported overdose education and nasal naloxone distribution (OEND) programs on rates of opioid related death from overdose and acute care utilization in Massachusetts. Design Interrupted time series analysis of opioid related overdose death and acute care utilization rates from 2002 to 2009 comparing community-year strata with high and low rates of OEND implementation to those with no implementation. Setting 19 Massachusetts communities (geographically distinct cities and towns) with at least five fatal opioid overdoses in each of the years 2004 to 2006. Participants OEND was implemented among opioid users at risk for overdose, social service agency staff, family, and friends of opioid users. Intervention OEND programs equipped people at risk for overdose and bystanders with nasal naloxone rescue kits and trained them how to prevent, recognize, and respond to an overdose by engaging emergency medical services, providing rescue breathing, and delivering naloxone. Main outcome measures Adjusted rate ratios for annual deaths related to opioid overdose and utilization of acute care hospitals. Results Among these communities, OEND programs trained 2912 potential bystanders who reported 327 rescues. Both community-year strata with 1-100 enrollments per 100 000 population (adjusted rate ratio 0.73, 95% confidence interval 0.57 to 0.91) and community-year strata with greater than 100 enrollments per 100 000 population (0.54, 0.39 to 0.76) had significantly reduced adjusted rate ratios compared with communities with no implementation. Differences in rates of acute care hospital utilization were not significant. Conclusions Opioid overdose death rates were reduced in communities where OEND was implemented. This study provides observational evidence that by training potential bystanders to prevent, recognize, and respond to opioid overdoses, OEND is an effective intervention.