摘要：The United States is in the midst of a prolonged and growing epidemic of accidental and preventable deaths associated with overdoses of licit and illicit opioids. For more than 3 decades, naloxone has been used by emergency medical personnel to pharmacologically reverse overdoses. The peers or family members of overdose victims, however, are most often the actual first responders and are best positioned to intervene within an hour of the onset of overdose symptoms. Data from recent pilot programs demonstrate that lay persons are consistently successful in safely administering naloxone and reversing opioid overdose. Current evidence supports the extensive scaleup of access to naloxone. We present advantages and limitations associated with a range of possible policy and program responses. RAPID INCREASES IN DEATHS from heroin-related overdose began in the 1990s, as average mortality per 100 000 population in 25 US cities increased from 8.7 in 1988 to 13.8 in 1997. 1 By 2004, poisoning was the second leading cause of death from unintentional injury in the United States. 2 Nearly all such deaths were attributed to illicit and prescription drugs, 2 fueled by a dramatic rise in the incidence of opioid-involved overdose, which paralleled similar increases in Denmark, Finland, Iceland, Norway, Sweden, Spain, Italy, Austria, Australia, England, and Wales. 3 – 5 Fatal overdose is the leading cause of death among those who misuse illicit drugs, exceeding mortality from AIDS, hepatitis, or homicide. 6 In a 33-year longitudinal study in California, 581 opiate-dependent participants had experienced an average of 18.3 years of potential life lost before age 65, 7 with heroin overdose accounting for the largest proportionate mortality (22.3%). The years of potential life lost for this group was 6 times greater than in the general US population. Although heroin-related overdose deaths have continued to rise, recently there has been an alarming increase in mortality from drug overdose associated with the misuse of prescription opioid analgesics. Data from the National Vital Statistics System indicate that the recent 62.5% increase in deaths from unintentional poisoning—from 12 186 in 1999 to 20 950 in 2004—was primarily attributable to increased misuse of prescription opioid analgesics. 2 According to mortality data on multiple causes of death from the National Center for Health Statistics, the number of opioid analgesic poisonings listed on death certificates increased 91.2% between 1999 and 2002; in the latter year, it accounted for 5528 deaths, more than those associated with either heroin or cocaine. 8 The current US epidemic of opioid-related overdoses is spreading geographically and demographically. Mortality from such overdoses is expanding from urban areas to suburban and rural regions, where overdoses are usually prescription related and general awareness and treatment services are relatively lacking. 9 Likewise, overdose mortality is on the rise among non-Hispanic Whites, women, adolescents and young adults, and those with a history of chronic pain and depression. 2 , 9 – 12 Methadone, oxycodone, hydrocodone, and fentanyl account for the vast majority of misused prescription opioids. 10 , 13 Common sources include not only illicit dealers but friends, relatives, physicians, and emergency departments. 11 For instance, in a study in rural southwestern Virginia, about half of the women who died of opioid-related overdose had prescriptions for the substance as well as a history of chronic pain, depression, or anxiety. 10
