Improving Naloxone Access and Its Effects on Drug Abuse and Overdoses

改善纳洛酮的获取及其对药物滥用和药物过量的影响

• 批准号: 9789120
• 负责人: David Powell
• 金额: $ 62.99万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789120
• 关键词: Improving; Naloxone; Access; Its; Effects

Project Summary/Abstract Opioid overdoses increased dramatically between 1999 and 2010. In 2010, 16,651 deaths were caused by a prescription opioid overdose, representing nearly 60% of all drug overdose deaths, and exceeding overdose deaths from heroin and cocaine combined. Recent modest declines in prescription opioid mortality rates have been paired with large increases in heroin abuse. In 2014, there were over 13,000 deaths involving heroin. In response to these trends, numerous federal and state policies have been adopted to curb the overdose rate. Improving access to naloxone through policy is especially promising as naloxone is known to be effective in reversing the life-threatening effects of opioids. Until relatively recently, however, naloxone has had a rather limited distribution network, followed by a recent wave of policy reforms motivated to improve naloxone access. The ability of policy to encourage additional naloxone access and subsequently reduce overdoses is generally unknown. In this project, we propose to study the ability of state policy to improve naloxone access and to understand which types of policies, if any, do so most effectively. We have preliminary evidence that permitting prescribers to dispense naloxone under their own authority is crucial for increasing naloxone prescribing. We will also place special emphasis on the responses of private pharmacies to state policies which legalize dispensing of naloxone without a patient- specific prescription. Large pharmacy chains have enacted their own private policies to improve naloxone access, and these policies have spread over time across several states. The effects of these private policies should vary geographically based the penetration of these chains in different communities. We will study whether private pharmacy policy can improve access and reduce overdoses above and beyond state policy. We will use a variety of rich data sets to measure our outcomes. We will use comprehensive quarterly zip code-level data on naloxone dispensing for 2010-2017. We will also collect data on pharmacy locations as well as pharmacy-level policy concerning naloxone dispensing. We will explore what types of state policy improve naloxone access and the role of pharmacy policy. We will subsequently test whether improved naloxone access affects fatal overdoses and nonfatal overdoses This project will present some of the first evidence of the effectiveness of naloxone policy on naloxone prescriptions while also exploring the mechanisms which make such policies most effective in terms of dispensing and reducing overdoses.

项目概要/摘要 1999 年至 2010 年间阿片类药物过量急剧增加。2010 年，16,651 死亡是由处方阿片类药物过量引起的，占所有药物的近 60% 过量死亡，以及海洛因和可卡因过量过量死亡的总和。最近的 处方阿片类药物死亡率小幅下降，同时死亡率大幅上升 海洛因滥用。 2014年，有超过13,000人因海洛因死亡。针对这些 随着趋势的发展，已经采取了许多联邦和州政策来遏制用药过量率。 通过政策改善纳洛酮的获取尤其有希望，因为众所周知，纳洛酮 有效逆转阿片类药物危及生命的影响。然而，直到最近， 纳洛酮的分销网络相当有限，紧随其后的是最近一波政策 改革旨在改善纳洛酮的获取。政策鼓励额外的能力 纳洛酮的获取和随后减少过量用药通常是未知的。 在这个项目中，我们建议研究国家政策改善纳洛酮获取的能力 并了解哪些类型的政策（如果有）最有效。我们有初步的 有证据表明，允许处方者在自己的权力下分配纳洛酮对于 增加纳洛酮处方。我们还将特别重视 私人药房遵守国家政策，使纳洛酮在没有患者的情况下配药合法化 具体处方。大型药房连锁店制定了自己的私人政策来改善 纳洛酮的使用，这些政策随着时间的推移已经传播到几个州。效果 这些私人政策的不同应根据这些链条在不同地区的渗透程度而有所不同 不同的社区。我们将研究私人药房政策是否可以改善获取和服务 减少超出国家政策的过量用药。 我们将使用各种丰富的数据集来衡量我们的结果。我们将使用 2010-2017 年纳洛酮配药的综合季度邮政编码级数据。我们将 还收集有关药房位置以及有关纳洛酮的药房政策的数据 配药。我们将探讨哪些类型的国家政策可以改善纳洛酮的获取以及纳洛酮的作用 药房政策。我们随后将测试改善纳洛酮的使用是否会影响致命性 药物过量和非致命药物过量 该项目将提供纳洛酮有效性的一些初步证据 纳洛酮处方政策，同时探索制定此类政策的机制 在分配和减少过量用药方面最有效。