Community-based intervention can help reduce mortality from opioid overdose

In a study of communities in Massachusetts with high numbers of opioid overdose deaths, implementation of overdose education and naloxone distribution (OEND) were associated with a significant reduction in opioid overdose death rates.

The study was led by researchers at Boston Medical Center (BMC), Boston University Schools of Medicine (BUSM) and Public Health (BUSMPH) in collaboration with the Massachusetts Department of Public Health (MDPH) and published in the British Medical Journal.

In the United States, increases in fatal overdose since the mid-1990s have been fueled by the growth in prescriptions for opioid analgesics, according to the study. Drug overdose has surpassed motor vehicle crashes to be the leading cause of death by injury in the United States. Overdose is also a major cause of death in Canada, Europe, Asia, and Australia. Opioid-related emergency department visits and hospital admissions have increased over the same period. In Massachusetts, since 2005, annual opioid-related overdose deaths have exceeded motor vehicle deaths.

OEND is a community-based intervention that educates people at risk for overdose and potential bystanders on how to prevent, recognize and respond to an overdose. It also equips these individuals with a naloxone rescue kit. Naloxone, which may be administered by injection or by nasal spray, is a safe and effective antidote that reverses the life-threatening effects of an opioid overdose. 

Between 2006 and 2009, Massachusetts OEND programs in 19 communities trained 2,912 potential bystanders who reported 327 rescues. Compared with no implementation, both low and high implementation of OEND were associated with lower rates of opioid related overdose deaths, when adjusted for demographics, addiction treatment utilization, and doctor shopping. Opioid overdose related visits to emergency departments and hospital admission rates did not differ significantly in communities with low versus high OEND implementation.

Study lead author Alexander Walley, MD, MSc, an attending physician in general internal medicine at BMC, and colleagues conducted an interrupted time series analysis of rates of opioid related deaths from overdose and acute care utilization from 2002 to 2009 that compared community-year strata with high and low rates of OEND implementation to those with no OEND implementation. Poisson regression models were adjusted for community-level demographics and substance use-related factors.

“OEND is an innovative, community-based program deployed in many settings that has not been examined in controlled studies,” Dr Walley told Formulary. “This study provides observational evidence that OEND is an effective public health intervention to address increasing mortality from opioid overdose by training potential bystanders to prevent, recognize, and respond to opioid overdoses. OEND implementation seemed to have a dose-related impact where the higher the cumulative rate of OEND implementation, the greater the reduction in death rates.”

This study provides strong support for the public health agency policy and community-based organization practice to implement and expand OEND programs as a key way to address the opioid overdose epidemic, according to Dr Walley. “Two features of the Massachusetts OEND programs that supported broad implementation include the use of an nasal naloxone delivery device and the use of a standing order issued by the health department, which allowed non-medical personnel to deliver OEND,” he said. “These features may enable broader implementation with greater impact as more communities implement OEND.”

“Opioid overdose death rates were reduced in communities where OEND was implemented,” Dr Walley said. “This study provides observational evidence that by training potential bystanders to prevent, recognize, and respond to opioid overdoses, OEND is an effective intervention.” ■