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

项目总结 从2020年5月到2021年4月，超过10万人死于药物过量，成为全球最大的 美国伤害死亡的原因。[1]服药过量死亡率的增加已基本得到控制 美国印第安人/阿拉斯加原住民(AI/AN)和黑人，AI/ANS吸毒率(29.8/100,000) 而黑人(27.3/10万)现在超过了非西班牙裔白人(23.6/10万)。 (NC)从2019年到2020年，AI/ANS的过量死亡率增加了75%以上，黑人增加了52%， 相比之下，非西班牙裔白人的增幅为19%。 应用纳洛酮是一种阿片类药物过量逆转药，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] 已促使国家大规模努力增加纳洛酮的供应。 社区药房，也由社区实体免费分发，如注射器服务 程序(SSP)。不幸的是，最近的研究记录了种族和地理上的差异 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，文献中还没有关于纳洛酮可利用度的全面测量的报道。 大多数关于纳洛酮可获得性的研究评估单一来源，如药房[11-16]或基于社区 计划，[17，18]留下了一幅不完整的图景，完全是社区一级的访问。我们的目标是开发一种 新的、全面的基于地点的纳洛酮可获得性测量，以记录 纳洛酮治疗。对于目标1，我们将与一个咨询委员会合作，创建一个新颖、全面的地方- 基于纳洛酮可利用度的测量。我们将结合从一项秘密购物者研究中收集的主要数据 社区药房和北卡罗来纳州有二次保险索赔的纳洛酮分销实体调查 数据，以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距 纳洛酮的有效性：(1)AI/AN和黑人社区；(2)农村人口；以及(3)高- 阿片类药物过量的风险。[20，21]对于目标3，我们将确定社会和社区因素，如 社区层面的社会隔离和与毒品有关的逮捕，调解了地理位置之间的关系 纳洛酮可获得性的地区和种族差异。这项研究将导致可视化工具的开发 以及显示种族和地理可获得性差异的地图，以便纳洛酮分发实体可以 协调努力，确保纳洛酮分配的公平性，防止阿片类药物过量死亡。我们还将 传播我们的测量开发框架，以便它可以在其他州容易地复制。

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.