Missouri naloxone distribution 2017–2023: Evaluation and implications of applying a naloxone saturation model

0 PSYCHOLOGY, CLINICAL
Kyle Vance B.A. , Brandon Park B.A. , Rithvik Kondai B.A. , Lauren Green MSW , Traci C. Green Ph.D. , Brandon D.L. Marshall Ph.D. , Rachel P. Winograd Ph.D.
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Abstract

Introduction

Overdose deaths have increased sharply in the past five years. States have implemented overdose education and naloxone distribution (OEND) initiatives to mitigate overdose deaths at a population level. Irvine et al. (2022) proposed a model to estimate amounts of naloxone needed to meaningfully reduce opioid overdose mortality (defined as naloxone saturation) by distributing it through: 1) community-based, 2) pharmacy-initiated, and 3) provider-based access points. In the most recent rounds of State Opioid Response grant applications, the Substance Abuse and Mental Health Services Administration (SAMHSA) required plans to reach naloxone saturation. Though SAMHSA funding has supported the growth of Missouri-based OEND, the outcomes of applying such a model are yet to be evaluated.

Methods

We used descriptive statistics and visual inspection to evaluate Missouri's naloxone distribution across agency types and years. Missouri's naloxone output was compared to observed opioid overdose fatalities and the naloxone need estimated by the model, which was at least 31,000 two-dose kits distributed through community-based settings to reach saturation.

Results

Missouri distributed over 400,000 naloxone kits from 2017 to 2023. In 2021, Missouri distributed 32,486 kits, passing the annual saturation threshold. Overall, street outreach/harm reduction services received the most naloxone (38.9 %), followed by treatment providers (13.6 %), recovery community centers (12.6 %), and social service providers (11.6 %). Missouri's opioid overdose death rate slowed in 2022 and began to discernibly decrease in 2023.

Conclusions

Missouri's naloxone distribution exceeded established saturation targets and evolved to include a wide variety of community access points, eventually coinciding with opioid overdose mortality reductions. Given the significant variability in overdose risk across populations and regions, the increasingly potent and volatile drug supply emerging since 2017, and the persistent risk of solitary drug use, more comprehensive response strategies are needed and saturation models should be updated to incorporate more specific geographic, racial/ethnic, and programmatic distribution targets.
密苏里州纳洛酮分布2017-2023:应用纳洛酮饱和度模型的评估和意义
在过去五年中,过量用药死亡人数急剧增加。各国实施了过量用药教育和纳洛酮分发(OEND)举措,以减轻人口一级的过量死亡。Irvine等人(2022)提出了一个模型来估计纳洛酮的数量,通过将其分配到:1)社区,2)药房发起和3)基于提供者的接入点来有意地降低阿片类药物过量死亡率(定义为纳洛酮饱和)。在最近几轮的国家阿片类药物应对拨款申请中,药物滥用和精神卫生服务管理局(SAMHSA)要求计划达到纳洛酮饱和。尽管SAMHSA的资金支持了密苏里州OEND的发展,但应用这种模型的结果尚未得到评估。方法采用描述性统计和目视检查对密苏里州纳洛酮在不同机构类型和年份的分布情况进行评价。将密苏里州的纳洛酮产量与观察到的阿片类药物过量死亡人数和模型估计的纳洛酮需求进行比较,该模型估计的纳洛酮需求至少需要通过社区环境分发31,000个双剂量试剂盒才能达到饱和。结果2017 - 2023年,密苏里州共发放纳洛酮试剂40余万套。2021年,密苏里州分发了32486套工具包,超过了年度饱和阈值。总体而言,街道外展/减少伤害服务机构接受纳洛酮最多(38.9%),其次是治疗提供者(13.6%)、康复社区中心(12.6%)和社会服务提供者(11.6%)。密苏里州的阿片类药物过量死亡率在2022年放缓,并在2023年开始明显下降。结论:密苏里州纳洛酮的分布超过了既定的饱和目标,并发展到包括各种各样的社区接入点,最终与阿片类药物过量死亡率的降低相一致。鉴于不同人群和地区的用药过量风险存在显著差异,2017年以来出现的药物供应日益强劲和不稳定,以及单独用药的风险持续存在,需要更全面的应对策略,并应更新饱和模型,以纳入更具体的地理、种族/民族和规划分布目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of substance use and addiction treatment
Journal of substance use and addiction treatment Biological Psychiatry, Neuroscience (General), Psychiatry and Mental Health, Psychology (General)
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