模拟阿片类药物使用障碍的药物治疗和纳洛酮对纽约州八个县阿片类药物过量死亡的同时影响。

IF 4.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Epidemiology Pub Date : 2024-05-01 Epub Date: 2024-02-19 DOI:10.1097/EDE.0000000000001703
Magdalena Cerdá, Ava D Hamilton, Ayaz Hyder, Caroline Rutherford, Georgiy Bobashev, Joshua M Epstein, Erez Hatna, Noa Krawczyk, Nabila El-Bassel, Daniel J Feaster, Katherine M Keyes
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引用次数: 0

摘要

背景:美国正处于阿片类药物过量流行的时期;2020 年,每 10 万人中有 28.3 人死于阿片类药物过量。模拟模型有助于理解和应对这一复杂、动态、非线性的社会现象。我们利用旨在减少阿片类药物过量的 "HEALing 社区研究 "和基于代理的模型 SiCLOPS(社区级药物过量预防策略模拟),模拟了丁丙诺啡的启动和保留以及纳洛酮的分发,目的是将纽约各县的药物过量死亡人数减少 40%:我们的模拟涵盖 2020-2022 年。八个县的城市或农村以及阿片类药物使用障碍治疗基线率的高低形成了鲜明对比。该模型校准了阿片类药物使用和使用障碍、治疗和治疗途径以及致命和非致命过量的代理特征。模型中的干预措施包括增加丁丙诺啡的使用和保留以及纳洛酮的分发。我们预测,在各种模型干预方案下,干预后 1 年阿片类药物致死过量率将下降:结果:各县需要独特的模型干预组合,才能将过量用药致死率降低 40%。假定纳洛酮在现有水平上增加 200%,高基线治疗县的过量用药死亡人数减少了 40%,同时丁丙诺啡的使用率增加了 150%。相比之下,低基线治疗县的丁丙诺啡使用量需要增加 250%-300%,同时纳洛酮的使用量需要增加 200%-1000%,具体取决于各县的情况:结果表明,有必要采取量身定制的县级干预措施,以提高服务利用率并减少用药过量死亡,因为干预措施的示范影响取决于各县在过去和当前干预措施方面的经验。
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Simulating the Simultaneous Impact of Medication for Opioid Use Disorder and Naloxone on Opioid Overdose Death in Eight New York Counties.

Background: The United States is in the midst of an opioid overdose epidemic; 28.3 per 100,000 people died of opioid overdose in 2020. Simulation models can help understand and address this complex, dynamic, and nonlinear social phenomenon. Using the HEALing Communities Study, aimed at reducing opioid overdoses, and an agent-based model, Simulation of Community-Level Overdose Prevention Strategy, we simulated increases in buprenorphine initiation and retention and naloxone distribution aimed at reducing overdose deaths by 40% in New York Counties.

Methods: Our simulations covered 2020-2022. The eight counties contrasted urban or rural and high and low baseline rates of opioid use disorder treatment. The model calibrated agent characteristics for opioid use and use disorder, treatments and treatment access, and fatal and nonfatal overdose. Modeled interventions included increased buprenorphine initiation and retention, and naloxone distribution. We predicted a decrease in the rate of fatal opioid overdose 1 year after intervention, given various modeled intervention scenarios.

Results: Counties required unique combinations of modeled interventions to achieve a 40% reduction in overdose deaths. Assuming a 200% increase in naloxone from current levels, high baseline treatment counties achieved a 40% reduction in overdose deaths with a simultaneous 150% increase in buprenorphine initiation. In comparison, low baseline treatment counties required 250-300% increases in buprenorphine initiation coupled with 200-1000% increases in naloxone, depending on the county.

Conclusions: Results demonstrate the need for tailored county-level interventions to increase service utilization and reduce overdose deaths, as the modeled impact of interventions depended on the county's experience with past and current interventions.

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来源期刊
Epidemiology
Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.70
自引率
3.70%
发文量
177
审稿时长
6-12 weeks
期刊介绍: Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.
期刊最新文献
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