First 2 Months of Operation at First Publicly Recognized Overdose Prevention Centers in US

Harocopos, Alex; Gibson, Brent E.; Saha, Nilova; McRae, Michael T; See, Kailin; Rivera, Sam; Chokshi, Dave A.

doi:10.1001/jamanetworkopen.2022.22149

Cited by 37 publications

(18 citation statements)

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“…One critical determinant for the effectiveness of naloxone distribution is the proportion of overdose events that are witnessed. In the midst of the social and physical isolation that has increased during the COVID-19 pandemic and the underlying stigmatization of drug use, it is crucial to find more ways to reduce events in which drug use occurs alone, such as supervised consumption sites, which were recently authorized by the state of Rhode Island and have the potential to reach individuals with the highest risk for overdose . Future studies should consider the potential effectiveness and cost of additional investments in these programs to expand their distribution capacities.…”

Section: Discussionmentioning

confidence: 99%

Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island

et al. 2022

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ImportanceIn 2021, the state of Rhode Island distributed 10 000 additional naloxone kits compared with the prior year through partnerships with community-based organizations.ObjectiveTo compare various strategies to increase naloxone distribution through community-based programs in Rhode Island to identify one most effective and efficient strategy in preventing opioid overdose deaths (OODs).Design, Setting, and ParticipantsIn this decision analytical model study conducted from January 2016 to December 2022, a spatial microsimulation model with an integrated decision tree was developed and calibrated to compare the outcomes of alternative strategies for distributing 10 000 additional naloxone kits annually among all individuals at risk for opioid overdose in Rhode Island.InterventionsDistribution of 10 000 additional naloxone kits annually, focusing on people who inject drugs, people who use illicit opioids and stimulants, individuals at various levels of risk for opioid overdose, or people who misuse prescription opioids vs no additional kits (status quo). Two expanded distribution implementation approaches were considered: one consistent with the current spatial distribution patterns for each distribution program type (supply-based approach) and one consistent with the current spatial distribution of individuals in each of the risk groups, assuming that programs could direct the additional kits to new geographic areas if required (demand-based approach).Main Outcomes and MeasuresWitnessed OODs, cost per OOD averted (efficiency), geospatial health inequality measured by the Theil index, and between-group variance for OOD rates.ResultsA total of 63 131 simulated individuals were estimated to be at risk for opioid overdose in Rhode Island based on current population data. With the supply-based approach, prioritizing additional naloxone kits to people who use illicit drugs averted more witnessed OODs by an estimated mean of 18.9% (95% simulation interval [SI], 13.1%-30.7%) annually. Expanded naloxone distribution using the demand-based approach and focusing on people who inject drugs had the best outcomes across all scenarios, averting an estimated mean of 25.3% (95% SI, 13.1%-37.6%) of witnessed OODs annually, at the lowest mean incremental cost of $27 312 per OOD averted. Other strategies were associated with fewer OODs averted at higher costs but showed similar patterns of improved outcomes and lower unit costs if kits could be reallocated to areas with greater need. The demand-based approach reduced geospatial inequality in OOD rates in all scenarios compared with the supply-based approach and status quo.Conclusions and RelevanceIn this decision analytical model study, variations in the effectiveness, efficiency, and health inequality of the different naloxone distribution expansion strategies and approaches were identified. Future efforts should be prioritized for people at highest risk for overdose (those who inject drugs or use illicit drugs) and redirected toward areas with the greatest need. These findings may inform future naloxone distribution priority settings.

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Section: Discussionmentioning

confidence: 99%

Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island

et al. 2022

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“…JAMA Network Open. 2022;5 (7) engagement with community, local, and state stakeholders. OPCs must also be informed by the needs of people whom they aim to help and ensure accessibility and inclusivity to not only have the desired public health impact, but also prevent perpetuating or exacerbating racial and gender inequities.…”

Section: + Related Articlementioning

confidence: 99%

“…Harocopos et al 7 describe patient encounters at OnPoint NYC's 2 OPCs in the first 2 months of operation. There were nearly 6000 visits by more than 600 individuals.…”

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confidence: 99%

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Overdose Prevention Centers: An Essential Strategy to Address the Overdose Crisis

2022

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In 2021, more than 107 000 people died from a drug overdose in the US, 1 a 15% increase from 2020.Deaths involving cocaine increased 23%, and deaths involving methamphetamines or other stimulants increased 34%. 1 Death rates are increasing the most rapidly among people experiencing homelessness 2 and among American Indian or Native American, Black, and Latinx individuals. 3 These staggering numbers demonstrate an urgent need for immediate action. In recent years, there has been expansion of proven harm reduction strategies to reduce overdose deaths. Harm reduction is a way of approaching and caring for people who use drugs that centers people's dignity, humanity, and autonomy to reduce harms associated with substance use. It uses practical strategies to meet people where they are to improve individual and community well-being and health. Decades of robust research on harm reduction strategies, specifically syringe services and naloxone distribution, demonstrate that these strategies are associated with reduced morbidity, mortality, and transmission of infectious diseases and improved individual health outcomes and services engagement and that they have high cost-effectiveness.The use of overdose prevention centers (OPCs) is an evidence-based harm-reduction intervention that, until recently, has not been available in the US. OPCs, which are sometimes referred to as supervised consumption centers, are places where people can consume preobtained drugs in a monitored setting where staff can immediately intervene in the event of an overdose.

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“…One promising new tool that could reach those receiving services across these settings is overdose detection technologies, such as the Never Use Alone telephone hotline [ 45 ] and the Brave smartphone application [ 46 ]. These technologies set up virtual safer use spaces, similar to brick-and-mortar overdose prevention centers, which are just beginning to emerge and operate in a minimal number of places in the USA [ 47 , 48 ]. These technologies connect callers about to use drugs with an operator who monitors and facilitates an emergency response if a caller becomes unresponsive.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of using opioids alone among individuals in a residential treatment program in Michigan: implications for overdose mortality prevention

et al. 2022

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Background Avoiding use of opioids while alone reduces overdose fatality risk; however, drug use-related stigma may be a barrier to consistently using opioids in the presence of others. Methods We described the frequency of using opioids while alone among 241 people reporting daily heroin use or non-prescribed use of opioid analgesic medications (OAMs) in the month before attending a substance use disorder treatment program in the Midwestern USA. We investigated drug use-related stigma as a correlate of using opioids while alone frequently (very often vs. less frequently or never) and examined overdose risk behaviors associated with using opioids while alone frequently, adjusted for sociodemographic and clinical characteristics. Results The sample was a median age of 30 years, 34% female, 79% white, and nearly all (91%) had experienced an overdose. Approximately 63% had used OAMs and 70% used heroin while alone very often in the month before treatment. High levels of anticipated stigma were associated with using either opioid while alone very often (adjusted PR: 1.20, 95% CI: 1.04–1.38). Drinking alcohol and taking sedatives within two hours of OAMs very often (vs. less often or never) and using OAMs in a new setting very often (vs. less often or never) were associated with using OAMs while alone very often. Taking sedatives within two hours of using heroin and using heroin in a new setting very often (vs. less often or never) were associated with using heroin while alone very often. Conclusion Anticipated stigma, polysubstance use, and use in a new setting were associated with using opioids while alone. These findings highlight a need for enhanced overdose harm reduction options, such as overdose detection services that can initiate an overdose response if needed. Addressing stigmatizing behaviors in communities may reduce anticipated stigma and support engagement and trust in these services.

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First 2 Months of Operation at First Publicly Recognized Overdose Prevention Centers in US

Abstract: This quality improvement study investigates outcomes and services used during the first 2 months of operation at the first 2 publicly recognized US overdose prevention centers.

Cited by 37 publications

References 4 publications

Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island

Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island

Overdose Prevention Centers: An Essential Strategy to Address the Overdose Crisis

Prevalence and correlates of using opioids alone among individuals in a residential treatment program in Michigan: implications for overdose mortality prevention

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