DAT-18-06 Prevention and Rescue Of Fentanyl and Other Opioid Overdoses Using Optimized Naloxone Distribution Strategies (PROFOUND)

DAT18-06。过量死亡正在以惊人的速度增加，特别是在受芬太尼影响的社区； 在这方面，迫切需要更有效和更有效率的战略来拯救生命。纳洛酮是一种阿片类药物 逆转阿片类药物过量的拮抗剂。纳洛酮在外行人群中的分布在 无法立即接触到急救人员时，或当人们目睹过量时，过量救援 不愿意或无法拨打911。目前纳洛酮在社区的分布有两种模式 美国：1)社区组织提供纳洛酮作为过量教育的一部分，并提供纳洛酮 针对过量用药风险人群及其社交网络中的管理人员的分发(OEND)计划 纳洛酮。有各种各样的组织参与，但对不同类型的OEND的情况知之甚少 这些计划接触到最有可能目睹过量服药的个人，以及提供服务的成本。2) 根据常规，许多州的药剂师可以在没有个人处方的情况下分配纳洛酮， FDA正在考虑将个别纳洛酮产品转换为非处方药(OTC)状态。药房 可用性、消费者接受度和自付成本因司法管辖区而异。纽约市(NYC) 主要城市中心，马萨诸塞州(MA)和罗德岛州(RI)，一个多州地区是司法管辖区 与芬太尼相关的阿片类药物迅速增加而深受影响的人口规模相似 而且正在迅速扩大纳洛酮的分布。人口规模相当(纽约市：8.6 ；MA/RI：790万)它们提供了探索不同政府实施的机会 不同地理环境中的权威机构(多个行政区的城市与多个州的地区)使用数据 在社区层面收集。他们的经验可以指导那些项目不那么健全的司法管辖区，因此 这些司法管辖区可以避免以下领域遇到的一些挑战和效率低下 很早就扩大了规模。我们的跨学科、经验丰富的调查团队一直在与 纽约市和MA/RI的政府机构和当地社区，以解决阿片类药物过量危机。我们 与这些合作伙伴合作提出以下研究目标：1)评估社区的影响- 纳洛酮在纽约市的分布水平战略，以及MA/RI关于最大限度减少阿片类药物过量死亡和 优化配置可用资源。我们将在当地模拟药物过量的影响和资源使用 社区层面使用数学模型。2)估计扩大药房的综合影响 纳洛酮分布和优化OEND分布对最大限度减少纽约和纽约地区阿片类药物过量死亡的影响 MA/RI。这一目标将通过应用统计方法来分析药学和规划数据来实现。3) 与政府机构和社区合作伙伴合作开发和测试资源分配工具， 可以根据阿片类药物的时间和地理变化更新纳洛酮分布靶点 纽约市和MA/RI的过量负担，具有与其他司法管辖区相关的特征。

DAT18-06. Overdose deaths are increasing at alarming rates, particularly in communities affected by fentanyl; in this context, more effective and efficient strategies are urgently needed to save lives. Naloxone is an opioid antagonist that reverses an opioid overdose. Naloxone distribution to laypersons plays a crucial role in overdose rescue when there is no immediate access to first responders, or when people witnessing overdoses are unwilling or unable to call 911. There are currently two models for community naloxone distribution in the US: 1) Community-based organizations provide naloxone as part of overdose education and naloxone distribution (OEND) programs for people at risk of overdose and people in their social networks to administer naloxone. A wide variety of organizations participate, but little is known about how well different types of OEND programs reach individuals most likely to witness an overdose, as well as the cost of providing services. 2) Pharmacists in many states can dispense naloxone without an individual prescription under a standing order, and FDA is considering converting individual naloxone products to over-the counter (OTC) status. Pharmacy availability, consumer acceptance, and out-of-pocket costs vary across jurisdictions. New York City (NYC), a major urban center, and the Massachusetts (MA) and Rhode Island (RI), a multi-state region are jurisdictions with similar population sizes that have been deeply affected by the rapid increase in fentanyl-related opioid overdoses and are rapidly scaling up naloxone distribution. With populations of comparable size (NYC: 8.6 million; MA/RI: 7.9 million) they provide opportunities to explore implementation by different government authority (city with multiple boroughs vs region with multiple states) in different geographic settings using data collected at the community level. Their experience can guide jurisdictions that have less robust programs, so that these jurisdictions can avoid some of the challenges and inefficiencies encountered by the areas that scaled up early. Our interdisciplinary, highly experienced team of investigators has been working closely with government agencies and local communities in NYC and MA/RI to address the opioid overdose crisis. We propose the following research aims in collaboration with these partners: 1) estimate the impact of community- level strategies for naloxone distribution in NYC, and MA/RI on minimizing opioid overdose fatalities and optimizing allocation of available resources. We will simulate overdose impact and resource use at the local community level using mathematical models. 2) Estimate the combined impact of expanding pharmacy naloxone distribution and optimizing OEND distribution on minimizing opioid overdose fatalities in NYC and MA/RI. This aim will be achieved by applying statistical methods to analyze pharmacy and program data. 3) Develop and test a resource allocation tool in collaboration with government agency and community partners, that can update naloxone distribution targets in response to temporal and geographic changes in the opioid overdose burden in NYC and MA/RI, with features that are relevant to other jurisdictions.