Overdose Education and Nasal Naloxone Rescue Kits for Bystanders Associated with Decreased Opioid Overdose Death
In a study of communities in Massachusetts with high numbers of opioid overdose deaths, the implementation of overdose education and naloxone distribution (OEND) was associated with a significant reduction in opioid overdose death rates. Led by researchers at Boston Medical Center (BMC), Boston University Schools of Medicine (BUSM) and Public Health (BUSPH) in collaboration with the Massachusetts Department of Public Health (MDPH) and published in the British Medical Journal (BMJ), this study provides observational evidence that OEND is an effective public health intervention to address the epidemic of fatal opioid overdose.
Opioids include substances such as heroin and prescription pain relievers, namely hydrocodone, oxycodone, codeine, morphine and fentanyl. The rate of opioid overdose continues to rise and is a major cause of preventable death. Opioid related overdose deaths have exceeded the number of motor vehicle deaths each year since 2005 in Massachusetts and are the leading cause of injury death in the commonwealth.
OEND is an innovative, 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 in 19 communities with a high prevalence of opioid overdose deaths, Massachusetts OEND programs organized, funded and supported by MDPH trained 2,912 potential bystanders who reported 327 rescues. After adjusting for community level factors, including the use of addiction treatment and doctor shopping for prescription opioids, communities with low levels of OEND training had 27 percent lower opioid overdose death rates and communities with high levels of OEND training had 46 percent lower opioid overdose death rates compared to communities with no training.
“Opioid overdose is a major public health problem for which we have few proven solutions. This study provides observational evidence that OEND can have a population-level dose effect in reducing overdose death rates, where the greater the implementation, the greater the impact,” said Alexander Walley, MD, MSc, an attending physician in general internal medicine at BMC and the study’s lead author. Walley is an assistant professor of medicine at BUSM and medical director for the MDPH’s Opioid Overdose Prevention Program. “Together with a recent study, which demonstrated that OEND is highly cost effective, it appears that OEND is a promising, scalable and affordable tool to save lives from opioid overdose.”
Funding for this study was provided by the Centers for Disease Control and Prevention under award number 1R21CE001602 (Principal Investigator: Walley). To view the article on the BMJ website, go to http://www.bmj.com/cgi/doi/10.1136/bmj.f174.
Submitted by Tiffany Groover, MD, MPH