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

DAT-18-06 使用优化的纳洛酮分配策略预防和救援芬太尼和其他阿片类药物过量（PROFOUND）

• 批准号: 10588267
• 负责人: Brandon David Lewis Marshall
• 金额: $ 66.7万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-15 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10588267
• 关键词: 911 call; Accident and Emergency department; Address; Affect; Area; Authorization documentation; Cessation of life; Cities; Collaborations; Communities; Data; Databases; Decision Making; Distributional Activity; Effectiveness; Fentanyl; Geography; Government; Government Agencies; Health Personnel; Individual; Intramuscular Injections; Intranasal Administration; Life; Massachusetts; Measures; Modeling; Monitor; Naloxone; Needle-Exchange Programs; New York City; Opioid; Opioid Antagonist; Overdose; Overdose reduction; Overdose reversal; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy Distributions; Pharmacy facility; Play; Policy Maker; Population; Population Sizes; Populations at Risk; Prevention; Prevention program; Prevention strategy; Research; Research Personnel; Resource Allocation; Resources; Rhode Island; Role; Services; Social Network; Social Work; Statistical Methods; Substance Use Disorder; System; Testing; United States; United States Dept. of Health and Human Services; Update; Work; acceptability and feasibility; authority; community organizations; cost; experience; first responder; flexibility; homeless shelters; mathematical model; opioid epidemic; opioid mortality; opioid overdose; overdose death; overdose education; overdose prevention; overdose risk; programs; response; scale up; social stigma; surveillance data; synthetic opioid; tool; treatment program

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.

DAT18-06。过量的死亡人数正在以惊人的速度增加，特别是在受芬太尼影响的社区中； 在这种情况下，迫切需要更有效，更有效的策略来挽救生命。纳洛酮是阿片类药物 逆转阿片类药物过量的拮抗剂。纳洛酮分布到外行人在 当无法立即接触急救人员或目睹过量服药的人时，过量救援 不愿意或无法致电911。目前有两种用于社区纳洛酮分布的型号 美国：1）基于社区的组织提供纳洛酮作为过量教育和纳洛酮的一部分 针对有用药过量的人和社交网络中的人的分发计划（OEND）计划 纳洛酮。各种各样的组织都参与其中，但对不同类型的OEND的了解知之甚少 计划接触到最有可能见证过量的个人以及提供服务的成本。 2） 许多州的药剂师可以在常规命令下没有个人处方的情况下分发纳洛酮， FDA正在考虑将单个纳洛酮产品转换为Over-counter（OTC）状态。药店 各司法管辖区的可用性，消费者接受和自付费用各不相同。纽约市（纽约市）， 主要城市中心以及马萨诸塞州（MA）和罗德岛（RI），多国家地区是司法管辖区 与芬太尼相关的阿片类药物迅速增加的人口大小相似 过量剂量，正在迅速扩大纳洛酮的分布。大小可比的种群（NYC：8.6 百万; MA/RI：790万）他们提供了探索不同政府实施的机会 权威（具有多个行政区与具有多个状态的城市）在不同的地理环境中使用数据 在社区一级收集。他们的经验可以指导计划较少计划的司法管辖区，因此 这些司法管辖区可以避免在这些地区遇到的一些挑战和低效率 提早扩大。我们的跨学科，经验丰富的调查人员团队一直与 纽约市和MA/RI的政府机构和当地社区解决阿片类药物过量危机。我们 提出以下研究的目的是与这些合作伙伴合作：1）估计社区的影响 - 纽约市纳洛酮分布的水平策略，以及最小化阿片类药物过量死亡的MA/RI 优化可用资源的分配。我们将在本地模拟过量的影响和资源使用 使用数学模型的社区级别。 2）估计扩展药房的综合影响 纳洛酮分布并优化纽约市阿片类药物过量死亡的OEND分布，并 ma/ri。该目标将通过应用统计方法来分析药房和程序数据来实现。 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来更新纳洛酮分布目标 纽约市和MA/RI的过量负担，其功能与其他司法管辖区有关。