Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis

Abstract

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.Design 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. Participants OEND was implemented among opioid users at risk for overdose, social service agency staff, family, and friends of opioid users.Intervention 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.Main outcome measures 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. IntroductionPoisoning, nine out of 10 of which are related to drug overdoses, 1 has surpassed motor vehicle crashes to be the leading cause of death by injury in the United States.2 Overdose is also a major cause of death in Canada, 3 Europe, 4 Asia, 5 6 and Australia. 7 In the United States, increases in fatal overdose since the mid-1990s have been driven by the growth in prescriptions for opioid analgesics 8 and their non-medical use. 9 10 Opioid related emergency department visits and admissions to hospital have increased over the same period.11 In Massachusetts, since Naloxone is an opioid antagonist that reverses the effects of opioid overdose. Overdose education and naloxone distribution (OEND) programs tackle overdose by educating people at risk for overdose and bystanders in how to prevent, recognize, and respond to an overdose. Participants in the program are trained to recognize signs of overdose, seek help, rescue breathe, use naloxone, and stay with the person who is overdosing. From 1996 through 2010, over 50 000 potential bystanders were trained by OEND programs in the United States, resulting in over 10 000 opioid overdose rescues with naloxone. 17 In March 2012, the United Nations Commission on Narcotic Drugs recognized overdose as a global pu...

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