Geographic variation in the provision of naloxone by pharmacies in Ontario, Canada: A population-based small area variation analysis

被引：11

作者：

Antoniou, Tony ^{[1
,2
,3
,4
,11
]}

McCormack, Daniel ^{[1
]}

Campbell, Tonya ^{[1
]}

Sutradhar, Rinku ^{[1
,5
,6
]}

Tadrous, Mina ^{[1
,7
,8
,11
]}

Lum-Wilson, Nancy ^{[9
]}

Leece, Pamela ^{[4
,6
,10
]}

Munro, Charlotte ^{[11
]}

Gomes, Tara ^{[1
,3
,5
,7
,11
]}

机构：

[1] ICES, Toronto, ON, Canada

[2] St Michaels Hosp, Dept Family & Community Med, Toronto, ON, Canada

[3] Unity Hlth Toronto, Toronto, ON, Canada

[4] Univ Toronto, Dept Family & Community Med, Toronto, ON, Canada

[5] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[6] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

[7] Univ Toronto, Fac Pharm, Toronto, ON, Canada

[8] Womens Coll Hosp, Toronto, ON, Canada

[9] Ontario Coll Pharmacists, Toronto, ON, Canada

[10] Publ Hlth Ontario, Toronto, ON, Canada

[11] Ontario Drug Policy Res Network, Toronto, ON, Canada

来源：

DRUG AND ALCOHOL DEPENDENCE | 2020年 / 216卷

关键词：

Harm reduction; Opioid use disorder; UNITED-STATES; OPIOID OVERDOSE; SEDATIVE-HYPNOTICS; RISK-FACTORS; DRUG; ENVIRONMENT; ATTITUDES; STIGMA;

D O I：

10.1016/j.drugalcdep.2020.108238

中图分类号：

R194 [卫生标准、卫生检查、医药管理];

学科分类号：

摘要：

Background: Regional variation in pharmacy-dispensed naloxone rates could create access disparities that undermine the effectiveness of this approach. We explored individual and public health unit (PHU)-level determinants of regional variation in naloxone distribution through the Ontario Naloxone Program for Pharmacies. Methods: We conducted a population-based study between April 1, 2017 and March 31, 2018. We calculated age- and sex-standardized pharmacy-dispensed naloxone rates for the 35 Ontario PHUs, and identified determinants of these rates using generalized estimating equations negative binomial regression. Results: The age- and sex-standardized pharmacy-dispensed naloxone rate in Ontario was 5.5 (range 1.8-11.6) kits per 1000 population. Variables associated with higher naloxone dispensing rates included opioid use disorder history [rate ratio (RR) 2.27; 95% confidence interval (CI) 1.75-2.96], opioid agonist therapy (RR 11.17; 95% CI 7.15-17.44), and PHU opioid overdose rate (RR 1.09 per 10 deaths; 95% CI 1.06-1.13). Pharmacy-dispensed naloxone rates were lower in rural areas (RR 0.83; 95% CI 0.73-0.94) and among individuals dispensed one (RR 0.72; 95% CI 0.65-0.79), two to five (RR 0.67; 95% CI 0.54-0.84) or 6-10 (RR 0.92; 95% CI 0.74-1.14) opioids in the prior year relative to those receiving no opioids. Conclusion: Pharmacy-dispensed naloxone programs are important components of a public health response to the opioid overdose crisis. We found considerable variation in pharmacy-dispensed naloxone rates that could limit program effectiveness, particularly in rural settings with limited access to health and harm reduction services..

引用

页数：7

共 47 条

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