Costs of opioid overdose education and naloxone distribution in New York City.

Background: Naloxone is an opioid antagonist medication that can be administered by lay people or medical professionals to reverse opioid overdoses and reduce overdose mortality. Cost was identified as a potential barrier to providing expanded overdose education and naloxone distribution (OEND) in New York City (NYC) in 2017. We estimated the cost of delivering OEND for different types of opioid overdose prevention programs (OOPPs) in NYC. Methods: We interviewed naloxone coordinators at 11 syringe service programs (SSPs) and 10 purposively sampled non-SSPs in NYC from December 2017 to September 2019. The samples included diverse non-SSP program types, program sizes, and OEND funding sources. We calculated one-time start up costs and ongoing operating costs using micro-costing methods to estimate the cost of personnel time and materials for OEND activities from the program perspective, but excluding naloxone kit costs. Results: Implementing an OEND program required a one-time median startup cost of $874 for SSPs and $2,548 for other programs excluding overhead, with 80% of those costs attributed to time and travel for training staff. SSPs spent a median of $90 per staff member trained and non-SSPs spent $150 per staff member. The median monthly cost of OEND program activities excluding overhead was $1,579 for SSPs and $2,529 for non-SSPs. The costs for non-SSPs varied by size, with larger, multi-site programs having higher median costs compared to single-site programs. The estimated median cost per kit dispensed excluding and including overhead was $19 versus $25 per kit for SSPs, and $36 versus $43 per kit for non-SSPs, respectively. Conclusions: OEND operating costs vary by program type and number of sites. Funders should consider that providing free naloxone to OEND programs does not cover full operating costs. Further exploration of cost-effectiveness and program efficiency should be considered across different types of OEND settings.

Delivering Opioid Overdose Prevention in Bars and Nightclubs: A Public Awareness Pilot in New York City.

Drug seizure data indicate the presence of fentanyl in the cocaine supplies nationally and in New York City (NYC). In NYC, 39% of cocaine-only involved overdose deaths in 2017 also involved fentanyl, suggesting that fentanyl in the cocaine supply is associated with overdose deaths. To raise awareness of fentanyl overdose risk among people who use cocaine, the NYC Department of Health and Mental Hygiene pilot tested an awareness campaign in 23 NYC nightlife venues. Although 87% of venue owners/managers were aware of fentanyl, no participating venues had naloxone on premises prior to the intervention. The campaign's rapid dissemination reached people at potential risk of opioid overdose in a short period of time following the identification of fentanyl in the cocaine supply. Public health authorities in states with high rates of opioid-involved overdose death should consider similar campaigns to deliver overdose prevention education in the context of a drug supply containing fentanyl.

Exploring willingness to engage with law enforcement among syringe service program participants in New York City.

BACKGROUND: In New York City (NYC), 1,487 unintentional overdose deaths occurred in 2017, largely driven by the presence of fentanyls in the illicit drug market. In response to fentanyl-involved overdoses, law enforcement entities both nationally and in NYC have taken a new interest in overdose events. This study explored attitudes toward and willingness to engage with police among NYC syringe service program (SSP) participants, a population likely to have had experiences with overdose and/or police. METHODS: Between March and July 2017, 332 surveys were conducted with a convenience sample of NYC SSP participants. RESULTS: Most respondents (76%) reported ever being arrested for a drug-related crime. Few respondents (5%) reported a previous arrest in the context of an overdose event. Of the 62 respondents who had witnessed an overdose in the previous 12 months, 25% had not called 911 because of concerns about law enforcement. Over half (51%) of all respondents reported they would not be willing to aid police in their investigation of the person who supplied the drugs. CONCLUSION: Police investigations of both fatal and non-fatal drug overdose events have the potential to exacerbate mistrust of law enforcement and discourage emergency medical service utilization among PWUD.

Characteristics of tobacco purchases in urban corner stores.

INTRODUCTION: To examine the prevalence and patterns of tobacco purchases at low-income, urban corner stores. METHODS: Data on tobacco products and other purchases were collected through direct observation of customers' purchases (n=6369) at 120 urban corner stores in Philadelphia, Pennsylvania, from April to September 2012. RESULTS: Overall 13% of corner store purchases included tobacco products. The majority (61%) of tobacco purchases did not include any other products, and 5.1% of all purchases from corner stores included a food or beverage and tobacco product. Approximately 24% of tobacco purchases were for lower-cost tobacco products such as cigars and cigarillos, and nearly 5% of tobacco purchases were an illegal purchase of a single, unpackaged tobacco product that is not intended for individual sale (ie, loosies). There was no difference in the average amount spent on food or beverages when purchased with (US$2.55, 95% CI: 2.21 to 2.88) or without (US$2.55, 95% CI: 2.48 to 2.63) tobacco products. CONCLUSIONS: In low-income, urban corner store settings, 87% of purchases did not include tobacco; most tobacco purchases did not include the sale of non-tobacco items and spending on non-tobacco items was similar whether or not tobacco was purchased. These findings can help inform retail-level tobacco sales decisions, such as voluntary discontinuation of tobacco products or future public health policies that target tobacco sales. The results challenge prevailing assumptions that tobacco sales are associated with sales of other products in corner stores, such as food and beverages.

Attitudes toward comparative effectiveness research and patient engagement among reproductive health clinicians.

AIM: To assess reproductive health clinicians' knowledge of and attitudes toward comparative effectiveness research (CER), patient-centered outcomes research (PCOR) and patient engagement in research. MATERIALS & METHODS: Web-based survey of reproductive health clinicians. RESULTS: Among 103 responding clinicians, familiarity with CER and PCOR was moderate (35 and 44%, respectively). Once definitions were provided, most respondents agreed with the potential positive impacts of CER and patient engagement (65-87%), the importance of PCOR (95-99%) and that their patients might be interested in engaging in research as more than subjects (93%). CONCLUSION: We found positive attitudes toward PCOR and CER, and a range of experiences with patient engagement in research. There may be untapped potential for PCOR and CER in the reproductive health field.