Creating a novel place-based measure to explain geographic variability in naloxone access to reduce opioid overdose deaths

PROJECT SUMMARY
From May 2020 to April 2021, more than 100,000 individuals died of a drug overdose, making it the leading cause of injury death in the United States.[1] The increase in the overdose death rate has been higher in American Indian/Alaska Native (AI/AN) and Black people, with the overdose rate of AI/ANs (29.8/100,000) and Blacks (27.3/100,000) now exceeding that of non-Hispanic Whites (23.6/100,000).[4] In North Carolina (NC) from 2019 to 2020, the overdose death rate has increased for multiple populations, specifically increasing by more than 75% for AI/ANs, 52% for Blacks, and 19% for non-Hispanic Whites.[25]
Distributing naloxone, an opioid overdose reversal agent, is an effective method for reducing opioid overdose deaths.[5, 6] The majority of overdose deaths involve opioids, including the synthetic opioid, fentanyl,[26] which has prompted large-scale national efforts to increase naloxone availability.[5] Naloxone can be purchased at community pharmacies and is also distributed for free by community-based entities, such as syringe service programs (SSPs). Unfortunately, recent studies have documented substantial variation in access to naloxone, which may contribute to growing differences in opioid overdose deaths across areas and populations.[7-10, 14, 31]
To our knowledge, no comprehensive measure of naloxone availability has been reported in the literature. Most studies of naloxone availability assess single sources, such as pharmacies[11-16] or community-based programs,[17, 18] leaving an incomplete picture of total community-level access. Our objective is to develop a novel, comprehensive place-based measure of naloxone availability in order to document variations in naloxone availability. For Aim 1, we will work with an Advisory Board to create a novel, comprehensive place-based measure of naloxone availability. We will combine primary data collected from a secret shopper study of community pharmacies and surveys of NC’s naloxone distribution entities with secondary insurance claims data to comprehensively document sources of naloxone by ZIP code. For Aim 2, we will examine whether specific geographic areas and specific populations, including those at high-risk of opioid overdose, have less naloxone availability than others in NC.[20, 21] For Aim 3, we will identify how social and community factors, such as neighborhood-level health literacy, mediate the relationship between geographic location and differences in naloxone availability. This study will result in visual tools and maps that display gaps in naloxone availability so that naloxone-distributing entities can make data-informed decisions on where to increase naloxone distribution to reduce geographic disparities in opioid overdose deaths in North Carolina. We will also disseminate our measurement development framework so it can be readily replicated in other states.

Grant Number: 5R01MD018085-04
NIH Institute/Center: NIH
Principal Investigator: Delesha Carpenter