Impact of the naloxone standing order on trends in opioid fatal overdose: an ecological analysis

<i>Background:</i> Maryland expanded its “Statewide Naloxone Standing Order” (NSO) in 2017 to eliminate training and prescription requirements for obtaining naloxone, improve naloxone access, help reverse opioid overdose, and reduce overdose fatality rates. <i>Objectives:</i> To assess the change in the trends of fatal opioid overdose rates following the expansion of the Naloxone Standing Order (eNSO) and its association with the social determinants of health (SDoH). <i>Methods:</i> Data on overdose deaths and SDoH from 2015–2019 was collected and analyzed using interrupted time series and multivariate Poisson regression models to study the change in trends and the associations. <i>Results:</i> There was a significant decrease in the rate of fatal overdoses after the intervention: prescription opioid estimate number of deaths declined by .25 per 100,000 (<i>p</i> = .02), heroin estimate number of deaths declined by 1.83 per 100,000 (<i>p</i> &lt; .001), fentanyl estimate number of deaths declined by 2.54 per 100,000 (<i>p</i> &lt; .001). After controlling for eNOS implementation in Maryland, state-level estimates with high proportions of female residents and those with bachelor’s degree or higher were associated with reduction in overdose, while state-level estimates with high proportions of African Americans and higher employment rates were associated with an increase in overdose. <i>Conclusions:</i> Our analysis shows that the expanded naloxone standing order is associated with reducing opioid-related overdose death rates. Even though we observed a significant reduction in overdose death rate in fentanyl-related deaths, the rate of deaths post-eNSO was still increasing, suggesting the need for additional measures to impact the rates of fentanyl.

背景：马里兰州于2017年扩展了其“全州纳洛酮通用医嘱（Statewide Naloxone Standing Order, NSO）”政策，取消了获取纳洛酮所需的培训与处方要求，以提升纳洛酮可及性、助力阿片类药物过量逆转，并降低过量致死率。
研究目标：本研究旨在评估纳洛酮通用医嘱扩展版（expanded Naloxone Standing Order, eNSO）实施后，阿片类药物过量致死率的趋势变化，及其与健康社会决定因素（Social Determinants of Health, SDoH）的关联。
研究方法：本研究收集并分析了2015至2019年的过量死亡与健康社会决定因素数据，采用间断时间序列分析与多变量泊松回归模型，探究趋势变化及相关关联。
研究结果：干预后，致死性过量事件发生率出现显著下降：处方阿片类药物相关预估死亡数每10万人中减少0.25例（p = 0.02），海洛因相关预估死亡数每10万人中减少1.83例（p < 0.001），芬太尼相关预估死亡数每10万人中减少2.54例（p < 0.001）。在控制马里兰州eNSO实施情况后，分析显示，州层面人口中女性占比较高、本科及以上学历人群占比较高的区域，过量事件发生率有所降低；而非裔美国人占比较高、就业率较高的区域，过量事件发生率则呈上升趋势。
结论：本研究分析表明，扩展版纳洛酮通用医嘱与阿片类药物相关过量致死率的降低存在关联。尽管我们观察到芬太尼相关过量致死率出现显著下降，但eNSO实施后芬太尼相关死亡数仍呈上升态势，这提示需采取额外干预措施以管控芬太尼相关过量致死率。