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Opioid overdose prevention with intranasal naloxone among people who take methadone
Abstract
Overdose education and naloxone distribution (OEND) is an intervention that addresses overdose, but has not been studied among people who take methadone, a drug involved in increasing numbers of overdoses. This study describes the implementation of OEND among people taking methadone in the previous 30 days in various settings in Massachusetts. From 2008 to 2010, 1553 participants received OEND who had taken methadone in the past 30 days. Settings included inpatient detoxification (47%), HIV prevention programs (25%), methadone maintenance treatment programs (MMTP) (17%), and other settings (11%). Previous overdose, recent inpatient detoxification and incarceration, and polysubstance use were overdose risks factors common among all groups. Participants reported 92 overdose rescues. OEND programs are public health interventions that address overdose risk among people who take methadone and their social networks. OEND programs can be implemented in MMTPs, detoxification programs, and HIV prevention programs.
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“This route of administration has been validated for both OT (6, 71) and NAL (72–74) in previous human studies”
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“…is consistent with other harm reduction strategies such as syringe services programming, Good Samaritan laws, naloxone distribution programs, and safe injection sites which have all been associated with reduced overdose mortality (McDonald & Strang, 2016; Sordo et al., 2017; Walley et al., 2013).”
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“Times of increased risk of overdose are at commencement of treatment, when take-away doses are commenced, and at cessation of treatment (Walley et al., 2013).”
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“6%, with a response rate among heroin-exposed persons of 86%, comparable to that reported elsewhere.(12,19,21) The response rate among prescription opioid-exposed individuals was lower, 71%, potentially because of more mixed substance use.”
BackgroundResultSpatial and neighborhood-level correlates of lay naloxone reversal events and service availability
Yi, G. T., Dayton, L., Uzzi, M., Browne, K., Konstantopoulos, A. D., & Latkin, C. A. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2022.103739 · Cited by 10
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“Moreover, while it is possible the effectiveness of providing THN is enhanced when combined with education and training on recognizing the signs of an overdose and how to correctly administer naloxone, current evidence that providing education and training provides additional benefit has not been well established (4,…”
Tin, Y., Castry, M., Bowers-Sword, R., Shantharam, S., Aldridge, A., Zarkin, G. A., Starbird, L. E., Linas, B. P., Barocas, J. A., & Morgan, J. R. (2023) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000001218 · Cited by 4
Naloxone for Outpatients at Risk of Opioid Overdose #328
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Latkin, C. A., Dayton, L., Davey-Rothwell, M. A., & Jones, A. A. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22020213 · Cited by 3
“Some MOUD programs do provide naloxone [34–36].”
Changing Law from Barrier to Facilitator of Opioid Overdose PreventionPreprint
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A clinical case of acute methadone poisoning in an infant child
Narzikulov, R. A., Lodyagin, A. N., Sinenchenko, A. G., Batotsyrenov, C. B., Rustamov, B. R., Лисица, И. А., & Zapasnikov, N. D. (2023) · Toxicological Review · doi:10.47470/0869-7922-2023-31-4-237-242 · Cited by 2
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“27,28 32 Variability exists among program access to naloxone in the ED with rates of uptake between 30% and 70% reported in one review.”
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Davis, M. P., Gamier, P., & Sloan, P. A. (2023) · Journal of Opioid Management · doi:10.5055/jom.2014.0229 · Cited by 2
Intravenous Use of Intranasal Naloxone: A Case of Overdose Reversal
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“organizations promoting harm reduction have been distributing naloxone nasal atomization kits; they trained high-risk users and companions in assembly/use of the kits.(10) Naloxone”
MethodGicquelais, R. E., Bohnert, A. S. B., & Fernandez, A. C. (2020) · Substance Abuse · doi:10.1080/08897077.2020.1784361 · Cited by 2
“education and response training or alternatively, can coordinate trainings through an external agency.(18) Further, Doe-Simpkins”
BackgroundWygonik, Q. R., Glassman, T., & Tucker‐Gail, K. (2021) · Journal of Drug Issues · doi:10.1177/00220426211006365 · Cited by 2
“Several researchers have concluded that members of the social networks of PWUO are likely to be the first responders to an opioid overdose (Jones et al., 2014; Lankenau et al., 2013; Walley et al., 2013).”
BackgroundInfluentialCommentary on Pierce et al. (2016): Raising the bar of addiction treatment—first do no harm
Banta‐Green, C. J., & Coffin, P. O. (2016) · Addiction · doi:10.1111/add.13228 · Cited by 2
Methadone use for acute opioid withdrawal in Tshwane shelters during the COVID-19 lockdown
Siemens, J.-M. A., Bhoora, U., & van Rensburg, M. N. S. J. (2023) · South African Family Practice · doi:10.4102/safp.v65i1.5708 · Cited by 1
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“The most widely used antidote in acute opioid poisoning is the administration of naloxone(8-10).”
Tait, R. J., & Lenton, S. R. (2014) · Addiction · doi:10.1111/add.12396
Review article: A SYSTEMATIC REVIEW OF THE CARDIOTOXICITY OF METHADONE
Alinejad, S., Kazemi, T., Zamani, N., Hoffman, R. S., Mehrpour, O., & Pereleman, R. O. (2015)
The Adoption Of Harm Reduction By Abstinence Program Staff: A Qualitative Analysis
Coe, M. (2021) · Scholarworks (University of Massachusetts Amherst) · doi:10.7275/8498410
A Feasibility Study of a Group-based Opioid Overdose Prevention Educational Intervention
Clark, A. K. (2015) · OhioLink ETD Center (Ohio Library and Information Network)
Willis, A. (2017) · IUScholarWorks (Indiana University) · doi:10.7912/c2/1204
Low-energy Bluetooth for Detecting Real-world Penetrance of Bystander Naloxone Kits: A Pilot Study
Lai, J. T., Chapman, B. P., Boyle, K. L., Boyer, E. W., & Chai, P. R. (2018) · Hawaii International Conference on System Sciences (HICSS) · doi:10.24251/hicss.2018.411
“Heroin overdose deaths have more than doubled from 2000 to 2014, triggering the growth of harmreduction programs aimed at 1) training non-medical personnel to recognize and respond to opioid overdoses, and 2) dispensing overdose rescue kits containing naloxone, the antidote for opioid overdose, to at-risk individuals…”
BackgroundSellen, K., Markowitz, B., Goso, N., Mulvale, A., Hunt, R., Handford, C. D., Klaiman, M., Wright, A., Charles, M., Sniderman, R., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-978690/v1
Formation sur la naloxone en clinique de médecine familiale, une mesure prometteuse
Grégoire, A. I., St-Pierre, K. L., Racine-Hemmings, F., Voisine, G., Courtois, E. B., Brunet, C., Marois-Pagé, E., Loslier, J., Williams, R., Berbiche, D., et al. (2021) · Drogues santé et société · doi:10.7202/1085174ar
“L’importance d’impliquer les proches a d’ailleurs été soulignée par une étude américaine, ciblant les patients traités avec méthadone, où la grande majorité des participants formés n’ont pas utilisé la naloxone sur eux-mêmes post-formation, mais plutôt sur un proche (Walley et al., 2013).”
BackgroundSwartz, J. A., Lin, Q., & Kim, Y. (2022) · medRxiv · doi:10.1101/2022.07.01.22277147
Metadata
- Authors
- Walley, A. Y., Doe-Simkins, M., Quinn, E., Pierce, C., Xuan, Z., & Ozonoff, A.
- Affiliations
- Boston University (US)
- Boston Children's Hospital (US)
- Venue
- Journal of Substance Abuse Treatment
- Publisher
- Elsevier BV
- Published
- 2013-02
- Volume
- 44
- Issue
- 2
- Pages
- 241-247
- ISSN
- 0740-5472 (ISSN-L)
- OpenAlex
- W1979851403
- Cited by
- 107
- References
- 49
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 8 · 2022: 7 · 2021: 7 · 2020: 8 · 2019: 11 · 2018: 6 · 2017: 11 · 2016: 16 · 2015: 13 · 2014: 10 · 2013: 3
- FWCI
- 8.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Substance Abuse Treatment (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention (1R21CE001602-02)
- 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
- opioid overdose prevention, intranasal naloxone, overdose education and naloxone distribution, methadone maintenance treatment, opioid use disorder, overdose risk factors, inpatient detoxification, HIV prevention programs, polydrug use, prison history, public health interventions
- MeSH terms
- Administration, Intranasal, Adult, Female, Humans, Male, Massachusetts, Methadone, Middle Aged, Naloxone, Narcotic Antagonists, Opioid-Related Disorders, Narcotics, Patient Education as Topic, Pilot Projects, Risk Factors, Substance Withdrawal Syndrome, HIV Infections, Young Adult, Opiate Substitution Treatment, Drug Overdose
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