Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies

Abstract

The opioid overdose epidemic is a major threat to the public's health, resulting in the development and implementation of a variety of strategies to reduce fatal overdose. Many strategies are focused on primary prevention and increased access to effective treatment, although the past decade has seen an exponential increase in harm reduction initiatives. To maximize identification of opportunities for intervention, initiatives focusing on prevention, access to effective treatment, and harm reduction are examined independently, although considerable overlap exists. Particular attention is given to harm reduction approaches, as increased public and political will have facilitated widespread implementation of several initiatives, including increased distribution of naloxone and policy changes designed to increase bystander assistance during a witnessed overdose.

Keywords: harm reduction; naloxone; opioid overdose; overdose; prescription drug abuse.

Figure 1

Opportunities to reduce overdose risk through primary prevention. There are multiple access points for primary prevention initiatives on an individual, friends and family, community, prescriber, and government level. Abbreviations: Prescription Monitoring Program (PMP), Prescription (Rx), Center for Disease Control (CDC), National Institute of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA).

Figure 2

Opportunities to reduce overdose risk by increasing treatment engagement. There are multiple access points for initiatives on an individual, friends and family, community, prescriber, and government level. Medication-assisted treatment augments counseling and behavioral therapies with medications, such as methadone or buprenorphine. Abbreviations: Prescription (Rx), Treatment (Tx), National Institute of Health (NIH), National Institute of Drug Abuse (NIDA), Medication-Assisted Treatment (MAT).

Figure 3

Opportunities to reduce overdose risk through harm reduction strategies. There are multiple access points for initiatives on an individual, friends and family, community, prescriber, and government level. Abbreviations: Food and Drug Administration (FDA); Overdose (OD); Prescription Monitoring Program (PMP), National Institute of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA).

Figure 4

State-by-State Good Samaritan, naloxone liability and third party prescribing laws. Infographic from Office of National Drug Control Policy (ONDCP) website showing which states have passed Good Samaritan, civil and criminal liability protection laws for lay administrator and prescribers, and third party prescribing laws as of December 1, 2014.