■尽管在更改为非处方状态之前,美国许多州的药房常规纳洛酮配药激增,很少有政策分析评估在解决社区阿片类药物过量死亡方面实施药房纳洛酮常规.
■确定与没有使用常规纳洛酮的药房的社区相比,使用常规纳洛酮是否与阿片类药物致死率较低有关。
■这项回顾性多地点研究是在24个季度(从2013年1月1日至2018年12月31日)对马萨诸塞州351个城市进行的中断时间序列分析。从所有主要连锁药店和许多独立药店的2个来源收集了常规纳洛酮配药数据,覆盖马萨诸塞州70%的零售药店。在研究期间,市政当局有各种常规的纳洛酮实施计划。数据从2021年12月到2023年11月进行了分析。
■主要暴露量是在第一季度以常规纳洛酮分配作为实际实施开始时进行测量的。
■主要研究结果是从马萨诸塞州生命记录和统计登记处获得的每10万人口的市政阿片类药物死亡率。
■351个城市的人口中位数(IQR)为10314人(3635至21781人),女性个体的平均(SD)比例为51.1%(2.8个百分点)。来自214个城市(60.9%)的药房报告在研究期间分配常规纳洛酮。在2013年第一季度的基线时,与从未实施常规纳洛酮的城市相比,最终使用常规纳洛酮的城市的季度阿片类药物死亡率更高(3.51vs1.03每10万人口死亡;P<.001)。在调整了市级社会人口统计学和阿片类药物预防因素后,阿片类药物死亡率有显著的斜率下降(年化比率,0.84;95%CI,0.78-0.91;P<.001)常规纳洛酮配药后,与未实施常规纳洛酮的市政当局相比。在调整后的模型中,阿片类药物死亡率没有显著水平变化。敏感性分析产生了相似且重要的发现。
■这些发现表明,社区药房常规配药纳洛酮与亲戚有关,渐进的,与未实施常规纳洛酮计划的社区相比,阿片类药物死亡率显着下降。这些发现支持扩大纳洛酮的使用范围,包括非处方纳洛酮作为解决阿片类药物过量的多方面方法的一部分。
UNASSIGNED: Despite the proliferation of pharmacy standing-order naloxone dispensing across many US states before the change to over-the-counter status, few policy analyses have evaluated the implementation of pharmacy naloxone standing orders in addressing opioid overdose fatality among communities.
UNASSIGNED: To determine whether the implementation of pharmacy standing-order naloxone was associated with lower opioid fatality rates compared with communities without
pharmacies with standing-order naloxone.
UNASSIGNED: This retrospective multisite study was conducted with an interrupted time series analysis across 351 municipalities in Massachusetts over 24 quarters (from January 1, 2013, through December 31, 2018). Standing-order naloxone dispensing data were collected from 2 sources for all major chain
pharmacies and many independent
pharmacies, covering 70% of retail
pharmacies in Massachusetts. Municipalities had various standing-order naloxone implementation inceptions during the study period. Data were analyzed from December 2021 to November 2023.
UNASSIGNED: The main exposure was measured by the first quarter with standing-order naloxone dispensation as the actual implementation inception.
UNASSIGNED: The primary study outcome was municipal opioid fatality rate per 100 000 population obtained from the Massachusetts Registry of Vital Records and Statistics.
UNASSIGNED: The median (IQR) population size across 351 municipalities was 10 314 (3635 to 21 781) people, with mean (SD) proportion of female individuals was 51.1% (2.8 percentage points).
Pharmacies from 214 municipalities (60.9%) reported dispensing standing-order naloxone over the study period. At the baseline of the first quarter of 2013, municipalities that eventually had standing-order naloxone had greater quarterly opioid fatality rates compared with those that never implemented standing-order naloxone (3.51 vs 1.03 deaths per 100 000 population; P < .001). After adjusting for municipal-level sociodemographic and opioid prevention factors, there was significant slope decrease of opioid fatality rates (annualized rate ratio, 0.84; 95% CI, 0.78-0.91; P < .001) following standing-order naloxone dispensing, compared with the municipalities that did not implement standing-order naloxone. There were no significant level changes of opioid fatality rates in the adjusted models. Sensitivity analyses yielded similar and significant findings.
UNASSIGNED: These findings suggest that community pharmacy dispensing of naloxone with standing orders was associated with a relative, gradual, and significant decrease in opioid fatality rates compared with communities that did not implement the standing-order naloxone program. These findings support the expansion of naloxone access, including over-the-counter naloxone as part of a multifaceted approach to address opioid overdose.