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

Adult Analgesics, Opioid / therapeutic use Drug Overdose / drug therapy Female Harm Reduction Humans Male Middle Aged Naloxone / therapeutic use Narcotic Antagonists / therapeutic use Ontario Opiate Substitution Treatment Opioid-Related Disorders / drug therapy Pharmaceutical Services Pharmacies Small-Area Analysis
Harm reduction Opioid use disorder

Journal

Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587

Informations de publication

Date de publication:
01 11 2020
Historique:
received: 01 06 2020
revised: 15 07 2020
accepted: 11 08 2020
pubmed: 7 9 2020
medline: 13 4 2021
entrez: 6 9 2020
Statut: ppublish

Résumé

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. 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. 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. 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..

Sections du résumé

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..

Identifiants

DOI: 10.1016/j.drugalcdep.2020.108238 PMID: 32891910
pubmed: 32891910
pii: S0376-8716(20)30403-8
doi: 10.1016/j.drugalcdep.2020.108238
pii:
doi:

Substances chimiques

Analgesics, Opioid 0
Narcotic Antagonists 0
Naloxone 36B82AMQ7N

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

108238

Subventions

Organisme : CIHR
ID : 410281
Pays : Canada

Informations de copyright

Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.

Auteurs

Tony Antoniou (T)

ICES, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Canada; Unity Health Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Canada.

Daniel McCormack (D)

ICES, Toronto, Ontario, Canada.

Tonya Campbell (T)

ICES, Toronto, Ontario, Canada.

Rinku Sutradhar (R)

ICES, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.

Mina Tadrous (M)

ICES, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Canada.

Nancy Lum-Wilson (N)

Ontario College of Pharmacists, Toronto, Ontario, Canada.

Pamela Leece (P)

Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Public Health Ontario Toronto, Ontario, Canada.

Charlotte Munro (C)

Ontario Drug Policy Research Network, Canada.

Tara Gomes (T)

ICES, Toronto, Ontario, Canada; Unity Health Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Canada. Electronic address: tara.gomes@unityhealth.to.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Geographic variation in the provision of...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Dépresseurs du système nerveux central › Stupéfiants › Analgésiques morphiniques › Geographic variation in the provision of...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Mésusage de médicament › Surdose › Mauvais usage des médicaments prescrits › Geographic variation in the provision of...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Comportement › Réduction des dommages › Geographic variation in the provision of...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Geographic variation in the provision of...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Geographic variation in the provision of...
questionsmedicales.fr › Composés polycycliques › Hydrocarbures aromatiques polycycliques › Phénanthrènes › Morphinanes › Naloxone › Geographic variation in the provision of...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Antagonistes narcotiques › Geographic variation in the provision of...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Ontario › Geographic variation in the provision of...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Traitement de substitution aux opiacés › Geographic variation in the provision of...
questionsmedicales.fr › Troubles mentaux › Troubles liés à une substance › Troubles liés à l'usage de substances psychotropes › Troubles liés aux opiacés › Geographic variation in the provision of...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services pharmaceutiques › Geographic variation in the provision of...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Pharmacies › Geographic variation in the provision of...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de regroupements › Analyse en petite superficie › Geographic variation in the provision of...