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Comparative Study
. 2013 Jan 30:346:f174.
doi: 10.1136/bmj.f174.

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

Alexander Y Walley  1 , Ziming Xuan, H Holly Hackman, Emily Quinn, Maya Doe-Simkins, Amy Sorensen-Alawad, Sarah Ruiz, Al Ozonoff
Affiliations
Comparative Study

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

Alexander Y Walley et al. BMJ. .

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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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: AYW, ZX, EQ, MDS, AS-A, and AO had support from the Center for Disease Control and Prevention grant 1R21CE001602-01 for this study; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Unadjusted unintentional opioid related overdose death rates in 19 communities with no, low, and high enrollment in overdose education and nasal naloxone distribution program in Massachusetts, 2002-09
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Fig 2 Unadjusted opioid related acute care hospital utilization rates in 19 communities with no, low, and high enrollment in overdose education and nasal naloxone distribution program in Massachusetts, 2002-09
See this image and copyright information in PMC

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