Opioid Overdose Prevention Programs Research Articles

OASAS will deliver free test strips and naloxone to New Yorkers

New Yorkers can get free fentanyl test strips, xylazine test strips and/or naloxone from the state Office of Addiction Services and Supports (OASAS). These can be requested from the local Opioid Overdose Prevention Program or a pharmacy, according to OASAS, if supplies are needed immediately. For a directory of Opioid Overdose Prevention Programs, go here. Delivery will take two weeks, according to OASAS. To order the test strips and naloxone, submit a request through the website: https://forms.ny.gov/s3/Harm‐Reduction‐Order‐Form. The initiative is paid for by the Opioid Settlement Fund.

Implementation of a North Dakota opioid misuse and overdose prevention program in West Virginia

BackgroundPharmacy has an important role in combating the opioid epidemic. However, there is a need for more consistency of programs and evidence-based practices across the country. ObjectivesTo describe how an evidence-based opioid misuse and overdose prevention program that originated in North Dakota was implemented in West Virginia and to compare program results between the two states including pharmacist interventions and patient screening for opioid misuse and overdose. Practice descriptionThis advancement in practice took place in participating North Dakota and West Virginia community pharmacies. Practice innovationAn evidence-based program that originated in North Dakota was implemented in West Virginia. The details of this collaboration are outlined in this manuscript. Evaluation methodsProgram screening and pharmacist intervention data were collected using DocStation, an online pharmacy patient management platform. ResultsThirty-four pharmacies in West Virginia implemented the program. Between April 2022 and September 2023, a total of 34 West Virginia pharmacies conducted 449 documented screenings compared to 12,105 screenings by 81 pharmacies in North Dakota over the same time. There were differences between the states with regard to the proportion of individuals screened as high-risk for opioid use disorder and individuals at risk of accidental opioid overdose likely attributable to different demographics. ConclusionAn opioid misuse and prevention program was successfully implemented in two states, which can serve as a model to implement similar programs in other pharmacies across the United States.

Factors Associated with Take Home Naloxone Refusal among Emergency Department Patients Participating in an Opioid Overdose Prevention Program

BackgroundIncreasing the equitable distribution of take home naloxone (THN) may result in reduced deaths from opioid overdose (OD). ObjectivesThe primary study objective is to describe the demographic and clinical characteristics of emergency department (ED) patients who decline THN. The findings of this descriptive study may generate new hypotheses for successful THN distribution. MethodsRetrospective chart review using prospectively collected program evaluation data from a single urban EDs Health Education THN database and electronic health record. Characteristics of participants who refused versus accepted THN were compared using Chi-square testing for categorical variables and t-tests for continuous variables. A multivariate model was built to assess associations of statistical and clinically relevant characteristics with THN refusal. ResultsA total of 711 ED patients were offered THN of which 334 (46%) declined. In unadjusted analysis, with the independent variable being refusal of the THN offer, being currently on medication for opioid use disorder (MOUD) was associated with a greater odds of refusal (OR 1.9, 95%CI 1.3-2.6) while any drug related overdose (OR 0.6, 95%CI 0.4-0.8) or being given a prescription for buprenorphine in the ED (OR 0.2, 95%CI 0.1-0.9) were both associated with a lower odds of refusal. ConclusionsDemographic characteristics did not differ between those who accept versus refuse THN. Patients already receiving MOUD were more likely to refuse THN while those starting MOUD in the ED were less likely to refuse THN. Further studies are needed to determine the root causes of patients’ declination of THN and develop targeted interventions to address these causes.

Community-led approaches to making naloxone available in public settings: Implementation experiences in the HEALing communities study

BackgroundExpanding public naloxone access is a key strategy to reduce opioid overdose fatalities. We describe tailored community-engaged, data-driven approaches to install and maintain naloxone housing units (naloxone boxes) in New York State and estimate the cost of these approaches. MethodsGuided by the Consolidated Framework for Implementation Research, we collected data from administrative records and key informant interviews that documented the unique processes employed by four counties enrolled in the HEALing Communities Study to install and maintain naloxone housing units. We conducted a prospective micro-costing analysis to estimate the cost of each naloxone housing unit strategy from the community perspective. ResultsWhile all counties used a coalition to guide action planning for naloxone distribution, we identified unique approaches to implementing naloxone housing units: 1) County-led with technology expansion; 2) County-led grassroots; 3) Small-scale rural opioid overdose prevention program (OOPP) contract and 4) Comprehensive OOPP contract including overdose education and naloxone distribution (OEND) to individuals. The first two county-led approaches had lower cost per naloxone dose disbursed ($28–$38) compared to outsourcing to an OOPP ($183–$266); costs depended on services added to installing and maintaining units, such as OEND. Barriers included competing demands on public health resources (i.e., COVID-19) and stigma toward naloxone and opioid use disorder. Geographic access was a barrier in rural areas whereas existing infrastructure was a facilitator in urban counties. The policy landscape in New York State, which provides free naloxone kits and financial support to OOPPs, facilitated implementation in all counties. ConclusionsIf a community has the resources, installing and maintaining naloxone housing units in-house can be less expensive than contracting with an outside partner. However, contracts that include OEND may be more effective at reaching target populations. Financial support from health departments and legislative authorization are important facilitators to making naloxone available in public settings.

Racial/ethnic differences in receipt of naloxone distributed by opioid overdose prevention programs in New York City

IntroductionWe evaluated racial/ethnic differences in the receipt of naloxone distributed by opioid overdose prevention programs (OOPPs) in New York City (NYC).MethodsWe used naloxone recipient racial/ethnic data collected by OOPPs from April 2018 to March 2019. We aggregated quarterly neighborhood-specific rates of naloxone receipt and other covariates to 42 NYC neighborhoods. We used a multilevel negative binomial regression model to assess the relationship between neighborhood-specific naloxone receipt rates and race/ethnicity. Race/ethnicity was stratified into four mutually exclusive groups: Latino, non-Latino Black, non-Latino White, and non-Latino Other. We also conducted racial/ethnic-specific geospatial analyses to assess whether there was within-group geographic variation in naloxone receipt rates for each racial/ethnic group.ResultsNon-Latino Black residents had the highest median quarterly naloxone receipt rate of 41.8 per 100,000 residents, followed by Latino residents (22.0 per 100,000), non-Latino White (13.6 per 100,000) and non-Latino Other residents (13.3 per 100,000). In our multivariable analysis, compared with non-Latino White residents, non-Latino Black residents had a significantly higher receipt rate, and non-Latino Other residents had a significantly lower receipt rate. In the geospatial analyses, both Latino and non-Latino Black residents had the most within-group geographic variation in naloxone receipt rates compared to non-Latino White and Other residents.ConclusionsThis study found significant racial/ethnic differences in naloxone receipt from NYC OOPPs. We observed substantial variation in naloxone receipt for non-Latino Black and Latino residents across neighborhoods, indicating relatively poorer access in some neighborhoods and opportunities for new approaches to address geographic and structural barriers in these locations.

Implementation of a Pharmacy Follow-Up Program for Dispensed Opioid Medications.

There have been multiple reported pharmacy initiatives to reduce opioid misuse and accidental overdose to address our nation's public health crisis. To date, there has not been a description in the literature of a community pharmacy follow-up initiative for dispensed opioids. A follow-up program was designed and implemented in community pharmacies as part of a previously developed opioid overdose and misuse prevention program (ONE Program). Five to twelve days after the dispensing of an opioid, pharmacy technicians called the patient to follow up on opioid safety topics. Pharmacy technicians used a questionnaire to inquire about medication disposal plans, if the patient was taking the medication more than prescribed, medication side effects, and if the patient needed a pharmacist consultation. The results from that questionnaire were documented. During the first 18 months of the follow-up program, 1789 phone calls were completed. Of those contacted, 40% were still using their opioid medication, and over 10% were experiencing side effects which triggered a pharmacist consult. Patients were reminded of proper medication disposal methods, and most patients (78%) desired to dispose of unused medication at the pharmacy medication disposal box. Follow-up phone calls post-opioid medication dispensing were shown to add value to a previously established opioid misuse and accidental overdose prevention program and allowed for the fulfillment of the Pharmacist Patient Care Process.

Application of The Consolidated Framework for Implementation Research to inform understanding of barriers and facilitators to the implementation of opioid and naloxone training on college campuses

BackgroundThe opioid epidemic in the US continues to worsen. Opioid-only and polysubstance-involved opioid overdose deaths are increasing among adolescents and young adults, who have limited knowledge of opioid overdose prevention, including recognition and response. College campuses have infrastructure to support national-level implementation of evidence-based public health strategies for providing opioid overdose prevention and naloxone training programs among this priority population. However, college campuses are an underutilized, understudied setting for this programming. To address this gap, we conducted research assessing barriers and facilitators to planning and implementing this programming on college campuses.MethodsWe held 9 focus groups among purposively selected campus stakeholders whose perceptions were important to understand in planning for the dissemination and implementation of opioid overdose prevention and naloxone training. Focus group scripts were informed by The Consolidated Framework for Implementation Research (CFIR) to query about perceptions of opioid and other substance use, opioid and other substance use-related resources, and naloxone administration training. We used a deductive-inductive, iterative approach to thematic analysis.ResultsThemes about implementation barriers included (1) the perception that problematic use of other (non-opioid) substances was more prevalent than opioid use on campus and focus on those substances would be a greater priority on college campuses; (2) student schedules were overwhelmed with academic commitments and extracurricular activities, making delivery of additional training challenging; (3) barriers related to the perceived complexity and decentralization of communication on campus, preventing students from knowing how to access substance use-related resources. Themes about implementation facilitators included (1) framing naloxone training as important in becoming a responsible leader on campus and in the broader community and (2) leveraging existing infrastructure, champions within existing campus groups, and tailored messaging to facilitate participation in naloxone training.ConclusionsThis is the first study to provide in-depth insights into potential barriers and facilitators to widespread, routine implementation of naloxone/opioid education on undergraduate college campuses. The study captured diverse stakeholder perspectives and was theoretically grounded in CFIR, contributing to the growing literature on the application and refinement of CFIR across diverse community and school contexts.

Using formative evaluation of a community-based opioid overdose prevention program to inform strategic communication for adoption, implementation, and sustainability

BackgroundOpioid addiction and overdose is a public health problem in the United States and is expected to remain with substance use increasing due to the COVID-19 pandemic. Communities that approach this issue through multi-sector partnerships experience more positive health outcomes. Understanding motivation for stakeholder engagement in these efforts is essential to successful adoption, implementation, and sustainability particularly in the shifting landscape of needs and resources.MethodsA formative evaluation was conducted on the C.L.E.A.R. Program in Massachusetts, a state heavily impacted by the opioid epidemic. A stakeholder power analysis identified appropriate stakeholders for the study (n = 9). The Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Surveys (n = 8) examined perception and attitudes on the program; motivations and communication for engagement; and, benefits and barriers to collaboration. Stakeholder interviews (n = 6) explored the quantitative findings in more detail. Surveys were analyzed using descriptive statistics and a content analysis with deductive approach was conducted for stakeholder interviews. The Diffusion of Innovation (DOI) Theory guided recommendations for communications to engage stakeholders.ResultsAgencies represented a range of sectors and the majority (n = 5) were familiar with the C.L.E.A.R. Program. Despite the many strengths of the program and existing collaboration, based on the coding densities of each CFIR construct stakeholders identified crucial gaps in the services the program provided and noted that the overall infrastructure of the program could be enhanced. Opportunities for strategic communication to address the stages of DOI align with the gaps identified in the CFIR domains to result in increased agency collaboration and expansion of services into the surrounding communities to ensure sustainability of the C.L.E.A.R. Program.ConclusionsThis study explored factors necessary for ongoing multi-sector collaboration and sustainability of an existing community-based program especially given the changing context from COVID-19. Findings informed both program revisions and communication strategies to promote the program to new and existing collaborating agencies and the community served, and identify effective communication approaches across sectors. This is essential for successful implementation and sustainability of the program, especially as it is adapted and expanded to address post-pandemic times.Trial registrationThis study does not report results of a health care intervention on human participants, however it was reviewed and determined an exempt study with the Boston University Institutional Review Board (IRB #H-42107).

Scaling opioid overdose prevention and naloxone dispensation among rural and small metro area pharmacists: findings from a qualitative study

ABSTRACT Background Community pharmacies offer a population-wide approach to scale opioid overdose prevention programs (OOPP). This qualitative study identified factors influencing implementation of New York State’s OOPP to inform the uptake of naloxone dispensation in rural and small metro area pharmacies. Methods In-person interviews were conducted among licensed retail, independent, or supermarket pharmacists (n = 60) in the mid-Hudson valley area of New York in high- and medium-overdose regions. The semi-structured 29-item survey captured attitudes and experiences related to pharmacy participation in naloxone dispensation. Results Data revealed pharmacist support for naloxone dispensation. Barriers to OOPP success included: (1) Insufficient retail pharmacy leadership support for administrative and clinical tasks for OOPP tasks; (2) excessive opioid analgesic prescribing by physicians; (3) limited uptake of naloxone by prescribers and patients; (4) out-of-pocket costs for patients to obtain naloxone; (5) lack of time, staffing, and space to provide opioid overdose prevention counseling; (6) concern for increased overdose fatalities and injection drug use in the pharmacy premises if pharmacists dispensed sterile syringes, naloxone, and/or Buprenorphine-naloxone; and (7) stigmatizing attitudes toward persons who use opioids. Conclusion Multi-level intervention efforts that include pharmacist-prescriber communication and training, and stigma-reducing efforts in rural and small metro area regions are needed.

Reducing the stigma surrounding opioid use disorder: evaluating an opioid overdose prevention training program applied to a diverse population

BackgroundThe opioid epidemic is a rapidly growing public health concern in the USA, as the number of overdose deaths continues to increase each year. One strategy for combating the rising number of overdoses is through opioid overdose prevention programs (OOPPs).ObjectiveTo evaluate the effectiveness of an innovative OOPP, with changes in knowledge and attitudes serving as the primary outcome measures.MethodsThe OOPP was developed by a group of medical students under guidance from faculty advisors. Training sessions focused on understanding stigmatizing factors of opioid use disorder (OUD), as well as protocols for opioid overdose reversal through naloxone administration. Pre- and post-surveys were partially adapted from the opioid overdose attitudes and knowledge scales and administered to all participants. Paired t-tests were conducted to assess differences between pre- and post-surveys.ResultsA total of 440 individuals participated in the training; 381 completed all or the majority of the survey. Participants came from a diverse set of backgrounds, ages, and experiences. All three knowledge questions showed significant improvements. For attitude questions, significant improvements were found in all three questions evaluating confidence, two of three questions assessing attitudes towards overdose reversal, and four of five questions evaluating stigma and attitudes towards individuals with OUD.ConclusionsOur innovative OOPP was effective not only in increasing knowledge but also in improving attitudes towards overdose reversal and reducing stigma towards individuals with OUD. Given the strong improvements in attitudes towards those with OUD, efforts should be made to incorporate the unique focus on biopsychosocial and sociohistorical components into future OOPPs.

Costs of opioid overdose education and naloxone distribution in New York City

Background: Naloxone is an opioid antagonist medication that can be administered by lay people or medical professionals to reverse opioid overdoses and reduce overdose mortality. Cost was identified as a potential barrier to providing expanded overdose education and naloxone distribution (OEND) in New York City (NYC) in 2017. We estimated the cost of delivering OEND for different types of opioid overdose prevention programs (OOPPs) in NYC. Methods: We interviewed naloxone coordinators at 11 syringe service programs (SSPs) and 10 purposively sampled non-SSPs in NYC from December 2017 to September 2019. The samples included diverse non-SSP program types, program sizes, and OEND funding sources. We calculated one-time start up costs and ongoing operating costs using micro-costing methods to estimate the cost of personnel time and materials for OEND activities from the program perspective, but excluding naloxone kit costs. Results: Implementing an OEND program required a one-time median startup cost of $874 for SSPs and $2,548 for other programs excluding overhead, with 80% of those costs attributed to time and travel for training staff. SSPs spent a median of $90 per staff member trained and non-SSPs spent $150 per staff member. The median monthly cost of OEND program activities excluding overhead was $1,579 for SSPs and $2,529 for non-SSPs. The costs for non-SSPs varied by size, with larger, multi-site programs having higher median costs compared to single-site programs. The estimated median cost per kit dispensed excluding and including overhead was $19 versus $25 per kit for SSPs, and $36 versus $43 per kit for non-SSPs, respectively. Conclusions: OEND operating costs vary by program type and number of sites. Funders should consider that providing free naloxone to OEND programs does not cover full operating costs. Further exploration of cost-effectiveness and program efficiency should be considered across different types of OEND settings.

Multi-informant Implementation and Intervention Outcomes of Opioid Overdose Education and Naloxone Distribution in New York City

Overdose Education and Naloxone Distribution (OEND) is an effective public health intervention to reduce opioid overdose fatalities (McDonald and Strang, Addiction 111:1177–1187, 2016). However, we know little about OEND implementation outcomes (i.e., indicators of implementation success), specifically the fidelity of training delivery, and how these may relate to intervention outcomes (i.e., indicators of the success or effectiveness of an intervention), such as overdose knowledge and attitudes. This study evaluated 16 OEND trainings conducted at different Opioid Overdose Prevention Programs in New York City. Trainees (N = 75) completed the Opioid Overdose Knowledge and Attitude Scales before and after training (intervention outcomes). Implementation outcomes were fidelity (competence and adherence of the trainer, N = 10; modified Fidelity Checklist) and acceptability of OEND (Acceptability of Intervention Measure), assessed from multiple perspectives (trainees, trainers, and an independent observer). Trainees’ overdose knowledge, t(71) = − 8.12, p < 0.001, 95% CI [− 6.54, − 3.96], and attitudes, t(65) = − 6.85, p < 0.001, 95% CI [− 0.59, − 0.33], improved significantly from pre- to post-training. Stepwise multiple regression models indicated that adherence of the trainer rated from the observer perspective added significantly to the prediction of changes in overdose knowledge, F(1, 67) = 9.81, p = 0.003, and explained 13% of the variance in outcome. However, fidelity measures from the perspective of trainees or trainers and acceptability of OEND were not associated with changes in trainees’ overdose knowledge or attitudes. OEND implementation outcomes and their relationship with intervention outcomes differed depending on the role of the fidelity rater in relation to the intervention. Specifically, our findings indicate that fidelity should be measured from an independent perspective (i.e., an individual who is experienced with fidelity rating but not directly involved in the intervention).

Community Case Study of Naloxone Distribution by Hospital-Based Harm Reduction Program for People Who Use Drugs in New York City.

Background: In 2017, The Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program at Mount Sinai Hospital became a registered Opioid Overdose Prevention Program (OOPP) and received funding from the New York City Department of Health and Mental Hygiene to develop a program to provide overdose education and naloxone distribution (OEND) training to at risk population and bystanders. We report on the programmatic quality improvement initiatives conducted. Methods: From April 2017 to December 2020, the REACH OOPP conducted 290 opioid overdose reversal trainings, throughout the Mount Sinai Health System and in multiple other community settings. OEND training was at times offered alone and in other settings alongside Hepatitis C Virus point of care testing. Additionally, a “train the trainer” model was implemented whereby medical students and nurses at outpatient clinics were trained to train others. Results: There were 4235 naloxone kits distributed to 3,906 participants. The training venues included hospital settings (patients and medical staff), public events, substance use programs, educational facilities, homeless prevention programs, faith-based organizations, alternative to incarceration programs, and community-based organizations. We implemented two types of training. During outreach sessions, we utilized one-on-one personalized sessions to train bystanders. When training clinic staff in the “train the trainer” model we utilized a standardized didactic presentation with slides. The two top reasons participants reported for being trained were “Just in case I see someone overdose” (59.3%) and “I'm worried that someone I know will overdose OR that I will overdose” (20.2%). Conclusion: The REACH program at Mount Sinai Hospital developed an effective model to train community bystanders and health care staff by leveraging administrative support and building on broader programmatic initiatives to promote drug user health and stigma-free care for people who use drugs. Hospitals do not currently mandate staff training or keeping naloxone stocked at inpatient units or outpatients clinics posing a challenge when implementing an OEND program in this setting. A recommended policy change needed to decrease overdose deaths is for hospitals to be required to implement systematic naloxone education and access for all health care personal and at risk patients.

Special Report from the CDC: Readiness to surge: State health departments’ workforce infrastructure during the opioid crisis

Introduction: As part of scaling up the response to the opioid overdose epidemic, there is an opportunity to examine how state public health departments addressed workforce and other infrastructure needs to implement a large-scale opioid overdose prevention program. Understanding how this was done—and any lessons learned from the process—can inform future workforce development and capital improvement efforts. Methods: Administrative data from the Centers for Disease Control and Prevention (CDC) Prescription Drug Overdose Prevention for States (PfS) program were analyzed to understand how states adapted to this emerging public health priority. Results: Six months into the first year of funding, 6 of the 16 state health departments had filled all anticipated staffing positions. States faced challenges obtaining timely expenditure authority and hiring staff. However, states were able to overcome these challenges by strategically reassigning staff, hiring from within, and utilizing existing contract mechanisms. Conclusion: Our analysis revealed how planning, using existing infrastructure, and maintaining a prepared workforce are critical to ensure that public health agencies have the ability to surge to meet emerging challenges and effectively utilize resources to achieve program goals. practical applications: Greater attention should be directed toward strategically addressing known barriers and timelines in work plans and budgets during the application and selection process to ensure implementation readiness.

Leveraging immersive technology to expand access to opioid overdose reversal training in community settings: Results from a randomized controlled equivalence trial

BackgroundImmersive video (e.g. virtual reality) poses a promising and engaging alternative to standard in-person trainings and can potentially increase access to evidence-based opioid overdose prevention programs (OOPPs). Therefore, the objective of this equivalence study was to test whether the immersive video OOPP was equivalent to a standard in-person OOPP for changes in opioid overdose knowledge and attitudes. MethodsA team of nurses and communication researchers developed a 9-minute immersive video OOPP. To test whether this immersive video OOPP (treatment) demonstrated equivalent gains in opioid overdose response knowledge and attitudes as in-person OOPPs (standard of care control), researchers deployed a two-day field experiment in Philadelphia, Pennsylvania, USA. In this equivalence trial, 9 libraries were randomly assigned to offer treatment or control OOPP to community members attending naloxone giveaway events. In this equivalence design, a difference between treatment and control groups pre- to post-training scores within -1.0 to 1.0 supports equivalence between the trainings. ResultsResults demonstrate participants (N = 94) exposed to the immersive video OOPP had equivalent improvements on posttest knowledge (β=-0.18, p = .61) and more favorable attitudes about responding to an opioid overdose (β=0.26, p = .02) than those exposed to the standard OOPP. However, these minor differences in knowledge and attitudes were within the equivalence interval indicating that the immersive video OOPP remained equivalently effective for community members. ConclusionsCommunity partnerships, like those between public health departments and libraries, can provide opportunities for deploying novel immersive video OOPP that, alongside standard offerings, can strengthen community response to the opioid crisis.

A model for an institutional response to the opioid crisis.

The use of opioid analgesics for pain management has increased dramatically over the past decade, with corresponding increases in negative sequelae including overdose and death. Physicians, policymakers, and researchers are focused on finding ways to decrease opioid use and overdose. This crisis calls for a coordinated response that includes the entire healthcare sector. In this work, the authors lay out a blueprint for such a response at the level of the academic medical center. The proposed model is a comprehensive opioid overdose prevention, response, and education program to evaluate, monitor, and address prescription opioid-related adverse events and addiction among all patients within a healthcare system. The approach includes three inter-related elements: (1) creation of an organizational structure that is subdivided into subcommittees to facilitate cross-functional collaboration and implementation. These subcommittees will focus on Research and Design, Implementation, Advisory, and Compliance with the recommendation. (2) Development of an effective communication plan throughout the institution to enable the organization to function seamlessly and efficiently as a single unit, (3) development of a data tracking and reporting system that intended to have a 360° view of all aspects of opioid prescription and downstream patient outcomes. The most effective response system will require an organizational structure that facilitates the ad hoc constitution of cross-functional teams with members drawn from all levels of the organizational hierarchy (executive leadership to frontline staff). Such a structure provides the teams with immediate solutions as developed by the frontline staff and authority to remove institutional barriers that may delay or limit the successful implementation. The model described was developed in our institution by a cross-functional team that included members from the Johns Hopkins School of Medicine and Johns Hopkins University Carey Business School, Department of Operations Management. The multidisciplinary nature of collaboration allowed us to develop a model for an immediate institution-wide response to the opioid crisis, and one that other healthcare organizations could adopt with local modification as a template for execution. The model also meant to serve as a template for an institutional rapid-response that can be seamlessly implemented during any future drug-related crisis or epidemic.

Tracking Community Naloxone Dispensing: Part of a Strategy to Reduce Overdose Deaths

Tracking Community Naloxone Dispensing: Part of a Strategy to Reduce Overdose Deaths

The impact of rural classification systems on a comparison of risky drug-related behaviors in Kentucky and Ohio counties

ABSTRACTTo analyze county-level differences in injection drug use (IDU) behaviors and overdoses in Kentucky and Ohio, and to assess the impact of using different models to classify counties as rural.Existing clinical data were pooled from three regional programs: 1) an opioid overdose prevention program (OOPP) within a residential addiction treatment program (n=163), 2) a regional evaluation of four OOPPs (n=655), and 3) a mobile syringe services program (n=1,379), representing 17 counties each in Kentucky (n=516) and Ohio (n=1,618). Pearson chi-square tests were used for dichotomous variables and an analysis of variance (ANOVA) was used to compare continuous variables. A Tukey HSD posttest was used to identify statistically significant comparisons.Age at first IDU was consistently younger in rural counties. However, findings changed based on the classification scheme used. This was also true for the prevalence of methamphetamine use.The rurality classification applied at the county level may be an important consideration in the analysis of research studies.

From the CDC: The Prevention for States program: Preventing opioid overdose through evidence-based intervention and innovation

Introduction: Since 1999, overdose deaths involving opioids have substantially increased. In 2016, 42,249 opioid-related deaths occurred—a 27.7% increase from the previous year (Hedegaard et al., 2017). As the nation's public health agency, the Centers for Disease Control and Prevention (CDC) has been actively involved in efforts to prevent opioid misuse, opioid use disorder, and opioid overdose since 2014. One of CDC's three principal opioid overdose prevention programs, the Prevention for States (PfS) program, began funding 16 state partners in August 2015 and then expanded to fund a total of 29 states in March 2016. The PfS program aims to prevent opioid morbidity and mortality by implementing evidence-based strategies such as enhancing and maximizing prescription drug monitoring programs (PDMPs) and implementing community or health systems interventions. Methods: In this article, we will describe the origins of the PfS program, provide an overview of program strategies, and locate PfS strategies in the larger landscape of nation-wide opioid overdose prevention efforts advanced by other partners and stakeholders. To describe the implementation of PfS, we offer an iterative model of using information to inform strategy selection, implementation, and evaluation. This model is a product of our observations of program implementation over time and has emerged, post hoc, as a helpful framework for organizing our insights and reflections on the work. Results: For each step of the model, we provide examples of how CDC has supported funded state partners in these efforts. Lastly, we describe innovative facets of the program and implications for both ongoing and future programs. Practical applications: Opioid overdose morbidity and mortality continues to increase across the United States. Adoption of the strategies and the program implementation paradigm described in this article when implementing prevention activities could improve the ability of public health programs to reverse this trend.

Commentary on Rege et al. (2018): Naloxone reports to US poison centers highlight overdose prevention opportunities.

Commentary on Rege et al. (2018): Naloxone reports to US poison centers highlight overdose prevention opportunities.