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Cited by 26Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesHIV, Drug Use, Sexual Risk

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

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Zang, Xiao, Bessey, Sam E., Krieger, Maxwell S., Hallowell, Benjamin D., Koziol, Jennifer A., Nolen, Shayla, Behrends, Czarina N., Murphy, Sean M. +4 more·2022·JAMA Network Open
DOI 10.1001/jamanetworkopen.2022.41174PMC PMC9647481
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Abstract

Importance: In 2021, the state of Rhode Island distributed 10 000 additional naloxone kits compared with the prior year through partnerships with community-based organizations. Objective: To 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 Participants: In 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. Interventions: Distribution 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 Measures: Witnessed OODs, cost per OOD averted (efficiency), geospatial health inequality measured by the Theil index, and between-group variance for OOD rates. Results: A 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 Relevance: In 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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Authors
Zang, X., Bessey, S. E., Krieger, M. S., Hallowell, B. D., Koziol, J. A., Nolen, S., Behrends, C. N., Murphy, S. M., Walley, A. Y., Linas, B. P., Schackman, B. R., & Marshall, B. D. L.
Affiliations
  • Brown University (US)
  • Rhode Island Department of Health (US)
  • Weill Cornell Medicine (US)
  • Boston Medical Center (US)
  • Boston University (US)
Corresponding author
Marshall, Brandon D. L.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2022-11-09
Volume
5
Issue
11
Pages
e2241174
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2022.41174
PMC
PMC9647481
OpenAlex
W4308750013
Cited by
26
References
41
Citations by year
2026: 6 · 2025: 7 · 2024: 9 · 2023: 4
FWCI
4.41
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
National Institute on Drug Abuse (U01DA047408, P30DA040500)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
naloxone distribution, opioid overdose deaths, community-based distribution, people who inject drugs, prescription opioid misuse, illicit opioid use, spatial microsimulation, cost-effectiveness, health disparities, Theil index, Rhode Island, harm reduction, overdose prevention
MeSH terms
Opiate Overdose, Delivery of Health Care, Humans, Naloxone, Rhode Island, Illicit Drugs, Health Status Disparities, Drug Overdose

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