{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:43:08Z","timestamp":1790750588383,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T00:00:00Z","timestamp":1729814400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T00:00:00Z","timestamp":1729814400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>During the COVID\u201019 pandemic, there was a surge in opioid overdose deaths (OODs) in Massachusetts, USA, particularly among Black and Hispanic\/Latinx populations. Despite the increasing racial and ethnic disparities in OODs, there was no compensatory increase in naloxone distributed to these groups. We aimed to evaluate two community\u2010based naloxone expansion strategies, with the objective of identifying approaches that could mitigate mortality and racial and ethnic disparities in OODs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Individual\u2010based simulation model. We measured naloxone availability using naloxone kits per OOD and evaluated scenarios of achieving higher benchmarks for naloxone availability (i.e. 40, 60 and 80 kits per OOD) from 2022 levels (overall: 26.0, White: 28.8, Black: 17.3, Hispanic\/Latinx: 18.9). We compared two naloxone distribution strategies: (1) proportional distribution: achieving the benchmark ratio at the overall population level while distributing additional kits proportional to the 2022 level for each racial\/ethnic group (at 40 kits per OOD benchmark: overall: 40, White: 44.3, Black: 26.6, Hispanic\/Latinx: 29.1), and (2) equity\u2010focused distribution: achieving the benchmark ratio among each racial\/ethnic group (at 40 kits per OOD benchmark: 40 for all groups).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Massachusetts, United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>People at risk of OOD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Annual number and rate of OODs, total healthcare costs of increasing naloxone availability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Both naloxone distribution strategies yielded comparable predicted reductions in total OODs in 2025 and incurred similar incremental costs. However, the relative reduction in the rate of OODs differed across groups. For achieving an 80 kits per OOD benchmark, proportional distribution resulted in a projected 6.7%, 6.5% and 7.1% reduction in annual OODs in 2025 among White, Black and Hispanic\/Latinx populations, respectively. In contrast, equity\u2010focused distribution achieved a reduction of 5.7%, 11.3% and 10.2% in the respective groups. In all scenarios, the cost per OOD averted was lower than the generally accepted thresholds for cost per life saved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An equity\u2010focused naloxone distribution strategy designed to reduce racial and ethnic disparities in naloxone availability could improve health equity among racial and ethnic groups while potentially improving overall population health at lower healthcare costs per opioid overdose death averted than a proportional distribution strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.16691","type":"journal-article","created":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T05:14:28Z","timestamp":1729833268000},"page":"316-326","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Improving racial\/ethnic health equity and naloxone access among people at risk for opioid overdose: A simulation modeling analysis of community\u2010based naloxone distribution strategies in Massachusetts, United States"],"prefix":"10.1111","volume":"120","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5722-8255","authenticated-orcid":false,"given":"Xiao","family":"Zang","sequence":"first","affiliation":[{"name":"Division of Health Policy and Management, School of Public Health University of Minnesota  Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Skinner","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health Brown University  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5470-866X","authenticated-orcid":false,"given":"Zongbo","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management, School of Public Health University of Minnesota  Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah C.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health Brown University  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3885-088X","authenticated-orcid":false,"given":"Czarina N.","family":"Behrends","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences Weill Cornell Medical College  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avik","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of General Internal Medicine Boston Medical Center and Boston University School of Medicine  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4349-1519","authenticated-orcid":false,"given":"Ali","family":"Jalali","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences Weill Cornell Medical College  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashly E.","family":"Jordan","sequence":"additional","affiliation":[{"name":"Center for Drug Use and HIV\/HCV Research  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1559-3983","authenticated-orcid":false,"given":"Jake R.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy and Management Boston University School of Public Health  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayla","family":"Nolen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health Brown University  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1132-2932","authenticated-orcid":false,"given":"Bruce R.","family":"Schackman","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences Weill Cornell Medical College  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0134-7052","authenticated-orcid":false,"given":"Brandon D. L.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health Brown University  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Y.","family":"Walley","sequence":"additional","affiliation":[{"name":"Massachusetts Department of Public Health, Bureau of Substance Addiction Services and Grayken Center for Addiction, Section of General Internal Medicine Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7006a4"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.0074"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7129e2"},{"key":"e_1_2_9_5_1","volume-title":"Drug overdose death rates","author":"National Institute on Drug Abuse","year":"2023"},{"key":"e_1_2_9_6_1","volume-title":"Opioid overdose death rates and all drug overdose death rates per 100,000 population (age\u2010adjusted)","author":"KFF"},{"key":"e_1_2_9_7_1","volume-title":"Current opioid statistics","author":"Massachusetts Department of Public Health"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30569-X"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2022.307037"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2022.0004"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.32314"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(21)00304-2"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.41174"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2017.06.005"},{"key":"e_1_2_9_15_1","first-page":"132","volume-title":"Expanding access to naloxone: a review of distribution strategies","author":"Weiner J","year":"2019"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2020.102376"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2022.306767"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-023-00736-7"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.15759"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109668"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.16324"},{"key":"e_1_2_9_22_1","volume-title":"Substance Abuse and Mental Health Services Administration","year":"2023"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.3338"},{"key":"e_1_2_9_24_1","volume-title":"Massachusetts behavioral health partnership","year":"2016"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2010.02990.x"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2006.07.009"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2002.00058.x"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-006-9156-0"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0951-8320(03)00058-9"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.3109\/09687637.2014.981509"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2021.103435"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0238618"},{"key":"e_1_2_9_33_1","volume-title":"Census","author":"Social Explorer Tables (SE)","year":"2020"},{"key":"e_1_2_9_34_1","volume-title":"National Survey on drug use and health: 2\u2010year RDSA (2018\u20102019)","author":"Substance Abuse and Mental Health Services Administration"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2018.304673"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2021.1986877"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2019.08.010"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.15879"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0227"},{"key":"e_1_2_9_40_1","volume-title":"Circular no. A\u20104, regulatory analysis","author":"The White House","year":"2023"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.16318"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2021.100869"},{"key":"e_1_2_9_43_1","volume-title":"Massachusetts opioid\u2010related overdose deaths rose 2.5 percent in 2022","author":"Massachusetts Department of Public Health","year":"2023"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108648"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-020-00439-5"},{"key":"e_1_2_9_46_1","volume-title":"Naloxone distribution program locator","author":"Massachusetts Bureau of Substance Addiction Services"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.15957"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108387"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103923"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2022-103591"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1093\/epirev\/mxac006"}],"container-title":["Addiction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.16691","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/add.16691","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.16691","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T02:41:41Z","timestamp":1773024101000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/add.16691"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,25]]},"references-count":50,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1111\/add.16691"],"URL":"https:\/\/doi.org\/10.1111\/add.16691","archive":["Portico"],"relation":{},"ISSN":["0965-2140","1360-0443"],"issn-type":[{"value":"0965-2140","type":"print"},{"value":"1360-0443","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,25]]},"assertion":[{"value":"2024-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}