Opioid Overdose Crisis Research Articles

The New York City (NYC) Office of Chief Medical Examiner (OCME) continues to be severely impacted by the ongoing opioid overdose crisis with over 3000 overdose deaths in 2022 alone. The National Association of Medical Examiners (NAME) recommends that autopsies be performed in all suspected overdose deaths, but this practice is difficult to maintain in the face of an unprecedented number of overdose deaths and a national shortage of forensic pathologists. Using an existing database of suspected overdose deaths (SPOT) maintained by the OCME Drug Intelligence and Intervention Group (DIIG), we sought to assess the ability to correctly certify subsets of suspected overdose deaths based only on known history and circumstances, external examination, and toxicology testing (View-Tox) using 6 exclusionary criteria for View-Tox eligibility (suspicion of criminality, suicide, trauma, hypothermia/drowning, epilepsy/seizures, and death in a public location). This process resulted in the exclusion of all homicides, suicides, non-overdose accidents, and most undetermined manner deaths. Of the remaining cases eligible for View-Tox, 99.2% could be correctly certified based only on toxicology testing results and information known before autopsy. This approach to overdose deaths would have resulted in a 32.8% reduction of autopsies in suspected overdose deaths at OCME in 2022.

Overdose Data to Action: A qualitative analysis of funded activities tailored for women.

The novel synthesized naltrexone-related MOR antagonist AT-99 counteracts dopamine releasing and behavioral depressant morphine-induced effects.

BackgroundThe opioid overdose crisis currently affecting Canada has resulted in thousands of deaths, and the COVID-19 pandemic has exacerbated the consequences of this crisis, particularly through the instability of the unregulated drug market. The province of Quebec is observing a similar pattern: the opioids consumed are more dangerous, and the number of overdoses is rising. Opioid use disorder (OUD) therefore represents a major public health issue. Offering appropriate interventions, such as opioid agonist therapy integrated into primary care, is one strategy to reduce the risk of death from overdose.ObjectiveThe aim of this research is to evaluate the implementation of an outreach clinic offering a low-threshold treatment program for OUD in Quebec. The secondary objective is to identify the factors that foster the participation in primary care research of people who are socially excluded and have current or past lived experience of OUD.MethodsThis study is being conducted in the Montérégie region of Quebec and comprises 3 phases: exploratory, photovoice, and participatory evaluation. The qualitative research adopts a participatory approach by involving people who are socially excluded and targeted by the outreach clinic’s services (eg, people experiencing homelessness and living with OUD). A committee of peer researchers, made up of experts with current or past lived experience of OUD, will be set up and will hold 10 meetings at various stages of the research. Two participant profiles will be involved: (1) health care professionals and community workers, who will take part in semistructured interviews; and (2) people with current or past lived experience of OUD, who will take part in the photovoice sessions or peer researcher committee meetings.ResultsThe peer researcher committee was formed in winter 2024, and 10 meetings had been held as of June 2025. As of August 2025, 4 photovoice sessions had been conducted, and 14 health care professionals and community workers had participated in the semistructured interviews. This study was funded in September 2022, with funding available through March 2025. Data were collected from September 2022 through June 2025. The analysis was finished in spring 2025. Results of the study are expected to be published in winter 2026.ConclusionsThe anticipated outcome is the establishment of an outreach clinic for OUD outside a major urban center, with a range of services tailored to the needs of people who are socially excluded and living with OUD. The coconstruction of this clinic in collaboration with people with current or past lived experience of OUD will enable an adequate response to the targeted population’s overall health needs and help reduce the barriers to access that they may face in conventional care structures.International Registered Report Identifier (IRRID)DERR1-10.2196/72457

The opioid overdose crisis has become a global public health emergency, claiming more than 100,000 lives each year. In North America, shifting opioid prescribing practices in response to the crisis have profoundly affected people living with chronic pain, who now face reduced access to prescription opioids. Against this backdrop, pain stakeholders have become increasingly active in policymaking arenas to shape how opioids and pain are understood. This study examines the Canadian Pain Task Force (CPTF) - a federal advisory body charged with creating a national pain strategy - by analyzing its reports, public and patient consultations, and internal documents. Through qualitative framing analysis, we find that stakeholders overwhelmingly depicted the overdose crisis as the result of illicit and irresponsible opioid use, while positioning stigma as both a driver and consequence of the crisis that compounded the challenges faced by people with chronic pain. From these problem definitions flowed policy proposals centered on expanding opioid access, reducing stigma, and advancing patient-centered care. These findings demonstrate how pain stakeholders shape, and are simultaneously shaped by, opioid policy debates - with consequences for both overdose prevention and chronic pain management.

A geospatial analysis of naloxone distribution patterns in the Massachusetts overdose education and naloxone distribution program (MA OEND).

Injectable buprenorphine during transition out of prison: A pilot partially randomized preference trial protocol.

People who use drugs (PWUD) come into frequent contact with the police including after calling for emergency medical services when witnessing an opioid overdose. Good Samaritan laws have been passed in many jurisdictions to protect people from prosecution if they call for emergency services. Other interventions have used police to connect people to harm reduction and drug treatment services. In contrast, more traditional policing practices that criminalize drug use persist, potentially increasing overdose risk and decreasing the likelihood that PWUD will call 911 in the case of an overdose. Little research has examined how all these different and contradictory policies have been implemented in practice. This paper presents data from in-depth interviews with 66 PWUD about their overdose experiences. Interviews explored the context in which overdose occurred; what actions participants took when witnessing an overdose, including whether they administered naloxone or called 911; and if they called 911, what law enforcement and emergency medical services (EMS) offered or did upon arrival (e.g. offer naloxone, refer to treatment, arrest, or confiscate drugs). Participants reported frequently being arrested following overdoses as there were many exceptions to the Good Samaritan Law. While in prison or jail, participants were not provided MOUD or naloxone and many experienced an overdose while in custody or shortly upon release. Few participants reported receiving referrals to drug treatment or ham reduction, and many described law enforcement officers' engaging in practices that discourage PWUD from calling 911.

Introduction Despite recent declines, the U.S. opioid overdose crisis persists. The HEALing Communities Study (HCS) aimed to reduce opioid overdose deaths through community-level adoption of evidence-based practices (EBPs), including overdose education and naloxone distribution (OEND) and medications for opioid use disorder (MOUD). This paper describes the reach of OEND and MOUD strategies implemented by the 33 HCS wait-list control communities. Methods We conducted descriptive statistical analysis of reach data collected from July 2022 through December 2023 to (1) summarize overall EBP implementation and reach and (2) compare the demographic representation of individuals reached to community demographic population estimates. Results Communities implemented 474 EBPs (251 OEND, 223 MOUD), reporting an average reach of 16,482 individuals monthly. For OEND, percent reached exceeded community population representation for individuals aged 18-34 years (40% vs 31%) and 35-54 years (41% vs 31%) and non-Hispanic Black individuals (20% vs 15%). For MOUD, percent reached exceeded the opioid use disorder population representation for individuals aged 35-54 years (58% vs 52%) and non-Hispanic White individuals (88% vs 80%); however, there was lower representation for individuals aged 18-34 years (28% vs 38%) and non-Hispanic Black individuals (6% vs 13%). Distributions by sex were comparable for OEND and MOUD. Conclusions Findings signal the promise of community-engaged interventions to reach diverse groups with OEND and reflect the challenges of overcoming longstanding barriers to MOUD access. This work provides practical examples for monitoring the reach of EBPs across multiple research sites and communities and for assessing representativeness, a valuable marker of equity. Trial Registration: Clinical Trials.gov http://www.clinicaltrials.gov: Identifier: NCT04111939

BackgroundImproving access to and retention in evidence-based treatment for opioid use disorder, including buprenorphine, is a critical response to the opioid overdose crisis. To increase the availability of buprenorphine treatment in primary care settings, the New York City Department of Health and Mental Hygiene implemented the Buprenorphine Nurse Care Manager Initiative in safety-net primary care clinics. The initiative funds nurse care managers to coordinate ongoing buprenorphine care and provides clinical support and technical assistance for implementation.MethodsAs part of a process evaluation of the initiative, we conducted in-depth interviews with 18 primary care providers new to prescribing buprenorphine and five nurse care managers across six organizations in New York City that participated in the Buprenorphine Nurse Care Manager Initiative between 2017 and 2019. We aimed to understand participating providers’ views on the successes and challenges of the initiative. Thematic and trajectory analytic approaches were used to capture major themes and changes over time.ResultsFindings show that participating providers valued many aspects of the initiative, suggesting that integrating buprenorphine treatment with the support of a nurse care manager into safety-net primary care clinics can effectively expand access to buprenorphine and quality of care for people with opioid use disorder in New York City.ConclusionsFindings from this process evaluation can inform future primary care-based buprenorphine treatment initiatives. Recommendations include ensuring ample nurse care manager support for primary care providers, robust mentorship structures, and organizational buy-in for initiative sustainability.

As the opioid overdose crisis continues to produce excessive morbidity and mortality in the United States, government agencies have applied various approaches to prevent overdoses, including law-enforcement efforts (e.g., arresting people who use drugs, interrupting drug traffickers, etc.) and treatment-based approaches (e.g., naloxone, medications for opioid use disorder, etc.). Public perception and support of these approaches are relevant for informing policy, allocating resources, and effectively implementing community interventions to prevent drug-related harms. Using an embedded informational survey design, we experimentally assessed whether public support for strategies to prevent overdose in South Carolina is influenced by language from federal agencies describing treatment- or enforcement-based approaches. Respondents were randomly assigned to one of three groups: (1) enforcement -based approach, (2) treatment-based approach, or (3) the control condition. Those assigned to experimental groups were presented with statistics on drug overdose deaths, followed by an informational prompt with language about overdose prevention approaches from either DEA (enforcement) or NIH (treatment), while the control group received no informational prompt. Findings from a sample of 4,675 respondents indicated that those assigned the DEA prompt were significantly more likely to support enforcement-based approaches in arresting drug traffickers and people who use drugs (AME = 0.060, p < 0.001). On the other hand, those assigned to the NIH prompt were significantly more likely to agree that both law enforcement (AME = 0.065, p < 0.0001) and clinicians (AME = 0.044, p < 0.05) are capable of preventing drug overdose deaths. These findings shed light on public perceptions of approaches to addressing the opioid epidemic and limited modifiability when presented with language from federal agencies. This may inform future research, practice, and/or policy aiming to maintain public safety while also providing treatment options to people who use drugs in order to reduce overdose deaths.

Importance: Lower back pain (LBP) contributes to a prevalent disease burden that is clinically and financially taxing to patients. Alternative non-pharmacological analgesic treatment methods can help alleviate symptoms while helping to fight the global opioid overdose crisis. Objective: This case report presents clinical findings of the successful use of frequency-specific microcurrent (FSM) therapy with brief stretching for treating LBP and reviews the secondary outcomes of accelerated increased flexibility. Design: Medical case report Setting: Outpatient setting Participant: 32-year-old female with chronic LBP Interventions: The patient received 10 FSM treatments over 3 weeks and performed the stand-and-reach stretch in the first 20 min of each FSM session. Measures: The primary outcome was numerical rating pain scale (NRPS) reduction or elimination of pain symptoms. The secondary outcome was the reduction in the fingertip-to-floor (FTF) distance when performing the toe touch test (TTT). Outcomes: After the second FSM treatment, the patient stopped having episodes of stiff restricted back pain following prolonged sitting. The patient’s measured FTF distance decreased by 27 cm from an initial baseline of 21 cm at the index fingertip landmark to a final FTF measurement of 2 cm at the flexed index finger metacarpophalangeal (MCP) joint tip landmark. Within each FSM session, the patient’s FTF distance decreased by a mean of 9.4 ± 1.2 cm between the pre- and post-session time points. Conclusions: FSM is clinically effective and efficient for treating unspecific chronic LBP. FSM can lead to accelerated increases in trunk flexibility levels, comparable to those found in athletes, with minimal effort by the patient, despite a sedentary lifestyle. Relevance: This case highlights the potential of off-label FSM therapy to improve range of motion and support flexibility goals in patients with medical conditions or injuries, as well as in athletes seeking to enhance physical performance.

The current opioid overdose crisis is significantly influenced by the evolving dynamics of drug markets, with fentanyl emerging as the predominant opioid in North America. Chronic pain remains a key driver of prescription opioid use among drug-using populations worldwide. This review examines the association between opioid misuse and chronic pain, particularly the transition from other prescribed analgesics to unprescribed fentanyl for pain management. We conducted a systematic review of literature from MEDLINE, CINAHL, Web of Science Core Collection, and PsycInfo using a combination of keywords, medical subject headings (MeSH), and Non-MeSH terms such as &amp;ldquo;fentanyl,&amp;rdquo; &amp;ldquo;chronic pain,&amp;rdquo; and &amp;ldquo;misuse.&amp;rdquo; All papers that described unprescribed fentanyl use to treat pain were included. After screening, 16 studies remained, including case studies, qualitative studies, observational cross-sectional studies, and retrospective observational studies. Findings indicate that motivation for street fentanyl use often stemmed from a lack of sufficient pain management from prescribed medications. The stigma surrounding opioid prescriptions emerged as a major barrier; patients expressed shame when requesting higher doses of opioids, and providers were hesitant to prescribe them. One limitation of this review is the small number of included studies and the heterogeneity of study designs, which may limit generalizability. Overall, our review found that un- or undertreated chronic pain is a critical reason fueling the shift toward fentanyl use in the current overdose crisis. Improvements in access to qualified pain treatment and targeted training for clinicians in opioid stewardship and pain monitoring may help reduce the number of street opioid users.

IntroductionAddressing the opioid overdose crisis requires developing contextually specific strategies promoting the adoption of evidence-based practices (EBPs) to prevent and treat opioid use disorder (OUD), including overdose education and naloxone distribution (OEND) and medications for OUD (MOUD). To effectively reach the groups most affected by the opioid crisis, EBP strategies must be adjusted to fit the culture and contexts of different communities. MethodsThe HEALing Communities Study engaged coalitions in 67 communities across four states to select and implement EBP strategies to reduce opioid overdose mortality. Coalitions were encouraged to culturally adapt EBP strategies for “special populations,” which were defined as groups that are highly impacted by OUD and face unique challenges in accessing prevention and treatment services. EBP strategies, and any efforts to culturally adapt them, were documented in coalition action plans. We collected quantitative and qualitative details from coalitions’ action plans. Following the first wave of the intervention (January 2020 – June 2022), we utilized the DATA (Describe, Analyze, Theorize, and ACT) model to evaluate the HEALing Communities Study approach to reaching special populations and identify areas for improvement. Finally, we identified variations across states in how cultural adaptation was interpreted and implemented. We provide strategies to improve how cultural adaption strategies are developed, documented, implemented, and monitored in future studies.ResultsCoalitions selected and implemented a variety of culturally tailored EBP strategies. However, complete understanding of the nature and effectiveness of cultural adaptation was limited by varying interpretations of what counts as cultural adaptation, inconsistent use of reporting guidance across research sites, and lack of data on the reach of each EBP strategy. Examples of cultural adaptation that successfully reached special populations included locating EBP strategies near each other to reduce transportation barriers, funding community-based organizations to help unhoused individuals meet basic needs, and hiring a bilingual and bicultural workforce to support prevention and treatment for OUD. Future studies should improve reporting of intersectional identities, measure EBP strategies’ reach, utilize real-world evidence of successful implementation strategies for cultural adaptation, and incorporate qualitative methods to contextualize cultural adaptation at local levels.ConclusionWe call on funders, researchers, evaluators, and implementers to invest in training and technical assistance, robust documentation and monitoring protocols, and thoughtful community engagement to support cultural adaptation of EBP strategies to reduce overdose for the most vulnerable populations.Trial registration: ClinicalTrials.gov Identifier: NCT04111939. Date of registration 10/01/2019.

Harm Reduction Research: A Vital Step in Combating the Opioid Overdose Crisis.

"There's no real urgency when it comes to us": Critical discourse analysis of Black communities' lived experience with opioid overdose response in Indianapolis area.

Background: The opioid overdose crisis remains a public health concern, and rates of suicide with opioid involvement have increased. Objective: To describe the prevalence of and factors associated with self-reported past 30-day suicide attempt or attempt "only when high or in withdrawal from alcohol or drugs" among reproductive-age women with past 30-day nonmedical prescription opioid use. Methods: Estimates are reported among women 18-55 years from 338 locations in 35 states using 2018-2020 National Addictions Vigilance Intervention and Prevention Program data. Bivariate analysis and multinomial logistic regression identified prevalence of and factors associated with past 30-day suicide attempt and attempt "only when high or in withdrawal from alcohol or drugs." Results: Among 10,095 women, 2.7% reported a past 30-day suicide attempt, and 1.5% reported an attempt "only when high or in withdrawal from alcohol or drugs." The largest magnitude of association for suicide attempt was extreme alcohol problem (adjusted odds ratio [aOR] = 2.84, 95% confidence interval [CI]: 1.80-4.47), and the largest magnitude of association for attempt "only when high or in withdrawal from alcohol or drugs" was no stable living arrangement (aOR = 2.66, 95% CI: 1.78-3.98). Conclusion: Comprehensive, upstream suicide prevention initiatives and substance use treatment can address factors associated with suicide attempt among reproductive-age women.

BackgroundDespite significant efforts to address the opioid overdose crisis, Black people who use drugs (PWUD) face unabating, disproportionate increases in opioid overdose death (OOD) rates. These inequities persist in treatment admissions, utilization of medication for opioid use disorder, and treatment retention. Research has linked neighborhood disinvestment — a process of urban decline driven by policy-related changes in neighborhood demand and desirability leading to decreased population, physical and economic erosion, and poorer quality of life for residents — to increased rates of OOD. However, given recent increases in OOD inequities, more research is needed to determine the specific aspects of neighborhood disinvestment that drive OOD risk among Black PWUD.MethodsThe current qualitative study utilized a community-engaged research approach to conduct focus groups with stakeholders providing support to PWUD in Black neighborhoods in order to identify the facets of neighborhood disinvestment that contribute and mitigate increases of OOD among Black PWUD in St. Louis, Missouri.ResultsThe resulting thematic analysis identified four themes linking neighborhood disinvestment to increased rates of OOD among Black PWUD: (1) a lack of access to congruent treatment and services, (2) intergenerational and socioemotional lack of mobility, (3) lack of financial accountability and investment from local leadership and government, and (4) the loss of collective community responsibility and engagement. A fifth theme brought attention to a culturally-grounded strategy being used to reduce these rates: (5) building engagement and community cohesion through grassroots efforts and street outreach.ConclusionsFindings provide key implications for policy and practice, including the importance of adopting a community-based research framework, offering financial management training for Black-led organizations, and harnessing community champions to implement culturally-tailored interventions aimed at reducing stigma and raising critical consciousness. Future work should aim to identify more effective community-driven solutions to address OOD in Black neighborhoods.

Background Community-based distribution of naloxone has continued to serve as an important strategy in combatting the U.S. opioid overdose crisis. People who use drugs are first responders in this crisis, administering and disseminating knowledge about naloxone among their social networks. However, it is unclear how knowledge of naloxone evolves over time and across individuals, especially amid a volatile, unregulated drug market. Objectives We conducted 22 qualitative interviews with people who use drugs in rural, suburban, and urban regions of Maryland. Interviews focused on respondents’ experiences witnessing and experiencing overdose, reversing overdoses with naloxone, and sources of uncertainty in overdose response. Results Participants demonstrated high willingness and capacity to respond to overdose using naloxone. However, limited technical knowledge about naloxone contributed to riskier overdose reversal strategies, especially among individuals who had not received formal training. Non-naloxone reversal strategies, such as rescue breathing, were not widely used by participants. Finally, perceived volatility within local drug markets, specifically fentanyl analogues and xylazine, undermined participants’ confidence in the effectiveness of naloxone. Conclusion People who use drugs serve an important role in community-based overdose reversal. Leveraging their experiential knowledge of overdose with technical knowledge of naloxone is foundational to effective community-based naloxone dissemination. Harm reduction programs should ensure that educational materials describe technical aspects of overdose response in ways that are intuitive to the experiences of people who use drugs, as well as ensure materials are responsive to an evolving drug supply.

Medicaid expansion is not associated with prescription opioid and benzodiazepine misuse among people who inject drugs: A serial cross-sectional observational study using generalized difference-in-differences models.