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Principal Investigator: Delesha Miller Carpenter
Organization: UNIV OF NORTH CAROLINA CHAPEL HILL
Fiscal Year: 2024
Award: $540,077
Funding agency: National Institute on Minority Health and Health Disparities
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.
Terms: <Actiq><Affect><Alaska Indian><Alaska Native><Alaska Native group><Alaska Native individual><Alaska Native people><Alaska Native population><Alaskan American><Alaskan Indian><Alaskan Native><Alaskan Native American><American Indian><American Indians><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Cessation of life><Communities><Community Pharmacy><Community Surveys><Data><Data Collection><Death><Death Rate><Decrease disparity><Development><Disparities><Disparity><Drug usage><Drugs><Duragesic><Economics><Ensure><Environment><Equity><Fentanest><Fentanyl><Fentyl><Geographic Area><Geographic Locations><Geographic Region><Geographical Location><Goals><Health><Health Status><Individual><Infrastructure><Injecting drug user><Injection Drug User><Injury><Level of Health><Literature><Low income><Lower disparity><Maps><Measurement><Measures><Mediating><Medication><Mental Health><Mental Hygiene><Methods><Naloxone><Narcan><Narcanti><Needle-Exchange Programs><Neighborhoods><Non-Hispanic><Nonhispanic><North Carolina><Not Hispanic or Latino><Opiates><Opioid><Overdose><Overdose reversal><PWID><Pharmaceutical Preparations><Pharmacies><Pharmacy facility><Phentanyl><Policies><Population><Privatization><Psychological Health><Reporting><Risk><Rural Community><Rural Population><Rural group><Rural people><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Social isolation><Source><Syringe-Exchange Programs><Time><United States><Update><Visual><Work><access disparities><accessibility disparities><community based organizations><community factor><community organizations><community-level factor><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><cost><developmental><disparities in access><disparities in race><disparity due to race><disparity reduction><distribute naloxone><drug use><drug/agent><economic><experience><geographic disadvantage><geographic disparity><geographic inequality><geographic inequity><geographic location disparity><geographic site><health level><health literacy><high risk><inequality due to race><inequality in access><inequity due to race><inequity in access><inequity in accessibility><injuries><insurance claims><mitigate disparity><mortality rate><mortality ratio><multidisciplinary><naloxone availability><naloxone dispensary><naloxone dispensation><naloxone dispensing><naloxone distribution><naloxone provision><needle exchange><novel><opiate deaths><opiate mortality><opiate overdose><opiate related overdose><opiate use disorder><opioid deaths><opioid drug overdose><opioid induced overdose><opioid intoxication><opioid medication overdose><opioid mortality><opioid overdose><opioid overdose death><opioid poisoning><opioid related death><opioid related overdose><opioid toxicity><opioid use disorder><overdose death><overdose fatalities><overdose risk><people who inject drugs><people who inject illicit drugs><persons who inject drugs><prevent><preventing><programs><provide naloxone><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial disparity><racial inequality><racial inequity><racially unequal><reduce disparity><reduction in disparity><reverse overdose><rural individual><segregation><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><social factors><substance use treatment><synthetic opiate><synthetic opioid><syringe exchange><syringe exchange services><syringe service programs><tool><treatment services><tribal community><vision development><visual development><visual system development><web site><website>