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

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Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., Ruiz, S., Ozonoff, A.·2013·BMJ
DOI 10.1136/bmj.f174PMC PMC4688551
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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. SETTING: 19 Massachusetts communities (geographically distinct cities and towns) with at least five fatal opioid overdoses in each of the years 2004 to 2006. 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.

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Authors
Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., Ruiz, S., & Ozonoff, A.
Affiliations
  • Boston University (US)
  • Massachusetts Department of Public Health (US)
Corresponding author
Walley, A. Y.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2013-01-30
Volume
346
Issue
jan30 5
Pages
f174-f174
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.f174
PMC
PMC4688551
OpenAlex
W2139852527
Cited by
999
References
2
Citations by year
2026: 44 · 2025: 56 · 2024: 96 · 2023: 56 · 2022: 88 · 2021: 106 · 2020: 98 · 2019: 104 · 2018: 87 · 2017: 80 · 2016: 76 · 2015: 59 · 2014: 36 · 2013: 12
FWCI
62.38
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • Bureau of Substance Addiction Services
  • Centers for Disease Control and Prevention (1r21ce001602-01, 1R21CE001602)
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, naloxone, opioid overdose deaths, bystander training, opioid overdose prevention, Massachusetts, harm reduction
MeSH terms
Adult, Allied Health Personnel, Analgesics, Opioid, Curriculum, Emergency Service, Hospital, Female, Health Education, Hospitalization, Humans, Male, Massachusetts, Naloxone, Narcotic Antagonists, Survival Rate, Harm Reduction, Prescription Drugs, Drug Overdose

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