Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis.
OBJECTIVE
To evaluate the impact of state supported overdose education and nasal naloxone distribution (OEND) programs on rates of opioid related death from overdose and acute care utilization in Massachusetts.


METHODS
Interrupted time series analysis of opioid related overdose death and acute care utilization rates from 2002 to 2009 comparing community-year strata with high and low rates of OEND implementation to those with no implementation.


METHODS
19 Massachusetts communities (geographically distinct cities and towns) with at least five fatal opioid overdoses in each of the years 2004 to 2006.


METHODS
OEND was implemented among opioid users at risk for overdose, social service agency staff, family, and friends of opioid users.


METHODS
OEND programs equipped people at risk for overdose and bystanders with nasal naloxone rescue kits and trained them how to prevent, recognize, and respond to an overdose by engaging emergency medical services, providing rescue breathing, and delivering naloxone.


METHODS
Adjusted rate ratios for annual deaths related to opioid overdose and utilization of acute care hospitals.


RESULTS
Among these communities, OEND programs trained 2912 potential bystanders who reported 327 rescues. Both community-year strata with 1-100 enrollments per 100,000 population (adjusted rate ratio 0.73, 95% confidence interval 0.57 to 0.91) and community-year strata with greater than 100 enrollments per 100,000 population (0.54, 0.39 to 0.76) had significantly reduced adjusted rate ratios compared with communities with no implementation. Differences in rates of acute care hospital utilization were not significant.


CONCLUSIONS
Opioid overdose death rates were reduced in communities where OEND was implemented. This study provides observational evidence that by training potential bystanders to prevent, recognize, and respond to opioid overdoses, OEND is an effective intervention.
Clinical Addiction Research Education Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA. awalley@bu.edu
Alexander Y
AY
Walley
Ziming
Z
Xuan
H Holly
HH
Hackman
Emily
E
Quinn
Maya
M
Doe-Simkins
Amy
A
Sorensen-Alawad
Sarah
S
Ruiz
Al
A
Ozonoff
D000328:Adult; D000488:Allied Health Personnel / Q000193:education; D000701:Analgesics, Opioid / Q000506:poisoning*; D003479:Curriculum; D062787:Drug Overdose / Q000401:mortality / Q000517:prevention & control; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D040261:Harm Reduction; D006266:Health Education / Q000379:methods*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D055553:Prescription Drugs / Q000506:poisoning; D015996:Survival Rate
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D055553:Prescription Drugs; D009270:Naloxone