Creating a novel place-based measure to explain racial disparities in naloxone access to reduce opioid overdose deaths

项目摘要 从2020年5月到2021年4月，超过10万人死于药物过量，使其成为全球最大的药物滥用者。 在美国造成死亡的原因。[1]过量死亡率的增加主要是由 美国印第安人/阿拉斯加原住民（AI/AN）和黑人，AI/AN的过量率（29.8/100，000） 黑人（27.3/100，000）现在超过了非西班牙裔白人（23.6/100，000）。[4]在北卡罗来纳州 (NC)从2019年到2020年，AI/AN的过量死亡率增加了75%以上，黑人增加了52%， 相比之下，非西班牙裔白人增加了19%。[25日] 分发阿片类药物过量逆转剂纳洛酮是减少阿片类药物过量的有效方法 死亡[5，6]大多数过量死亡涉及阿片类药物，包括合成阿片类药物芬太尼，[26] 促使全国大规模努力增加纳洛酮的可用性。[5]纳洛酮可在 社区药房也免费提供，如注射器服务 方案（SSP）。不幸的是，最近的研究表明， 纳洛酮，这可能导致阿片类药物过量死亡的差异越来越大。[7-10、14、31] 据我们所知，文献中尚未报道纳洛酮可用性的综合指标。 大多数纳洛酮可用性研究评估单一来源，如药房[11-16]或社区 方案，[17，18]留下了一个完整的社区一级访问的图片不完整。我们的目标是发展一个 一种新的、全面的基于地点的纳洛酮可用性测量方法，以记录 纳洛酮接入。对于目标1，我们将与顾问委员会合作，创建一个新颖、全面的场所- 基于纳洛酮可用性的测量。我们将联合收割机的主要数据收集从一个秘密的购物者研究， 社区药房和调查NC的纳洛酮分销实体与二级保险索赔 数据，通过邮政编码全面记录纳洛酮的来源。对于目标2，我们将估计以下方面的差异： 纳洛酮的可用性：（1）AI/AN和黑人社区;（2）农村人口;（3）高- 阿片类药物过量的风险。[20，21]就目标3而言，我们会找出社会及社区因素，例如 社区一级的社会隔离和与毒品有关的逮捕，调解地理之间的关系， 纳洛酮可用性的位置和种族差异。这项研究将导致视觉工具的发展 以及显示可用性的种族和地理差异的地图，以便纳洛酮分销实体可以 协调努力，确保公平分配纳洛酮，以防止阿片类药物过量死亡。我们还将 传播我们的计量发展框架，以便在其他国家推广。

PROJECT SUMMARY From May 2020 to April 2021, more than 100,000 individuals died of a drug overdose, making it the leading cause of injury death in the United States.[1] The increase in the overdose death rate has primarily been borne by American Indian/Alaska Native (AI/AN) and Black people, with the overdose rate of AI/ANs (29.8/100,000) and Blacks (27.3/100,000) now exceeding that of non-Hispanic Whites (23.6/100,000).[4] In North Carolina (NC) from 2019 to 2020, the overdose death rate increased by more than 75% for AI/ANs and 52% for Blacks, compared to a 19% increase for non-Hispanic Whites.[25] Distributing naloxone, an opioid overdose reversal agent, is an effective method for reducing opioid overdose deaths.[5, 6] The majority of overdose deaths involve opioids, including the synthetic opioid, fentanyl,[26] which has prompted large-scale national efforts to increase naloxone availability.[5] Naloxone can be purchased at community pharmacies and is also distributed for free by community-based entities, such as syringe service programs (SSPs). Unfortunately, recent studies have documented racial and geographic disparities in access to naloxone, which may contribute to growing disparities in opioid overdose deaths.[7-10, 14, 31] To our knowledge, no comprehensive measure of naloxone availability has been reported in the literature. Most studies of naloxone availability assess single sources, such as pharmacies[11-16] or community-based programs,[17, 18] leaving an incomplete picture of total community-level access. Our objective is to develop a novel, comprehensive place-based measure of naloxone availability in order to document disparities in naloxone access. For Aim 1, we will work with an Advisory Board to create a novel, comprehensive place- based measure of naloxone availability. We will combine primary data collected from a secret shopper study of community pharmacies and surveys of NC’s naloxone distribution entities with secondary insurance claims data to comprehensively document sources of naloxone by ZIP code. For Aim 2, we will estimate disparities in naloxone availability for: (1) AI/AN and Black communities; (2) rural populations; and (3) populations at high- risk of an opioid overdose.[20, 21] For Aim 3, we will identify how social and community factors, such as community-level social segregation and drug-related arrests, mediate the relationship between geographic location and racial disparities in naloxone availability. This study will result in the development of visual tools and maps that display racial and geographic disparities in availability so that naloxone-distributing entities can coordinate efforts to ensure equity in naloxone distribution to prevent opioid overdose deaths. We will also disseminate our measurement development framework so it can be readily replicated in other states.