Reduce Overdose Mortality Research Articles

A scoping review of the association between the built environment and overdose mortality.

Introduction The COVID-19 pandemic had a devastating impact on people who use drugs (PWUD). Reductions in access to harm reduction tools and treatment services elevated rates of fatal overdose for many. We explore the mechanism through which these factors influenced the rise in overdose mortality during COVID-19 from the perspective of people with overdose encounters. Methods We conducted in-depth, semi-structured, 60-minute telephone-based interviews with 43 overdose survivors and witnesses between January and May 2022. Participants were from nine states (ME, MI, MD, NJ, NY, NM, PA, TN, WV) and Washington, DC. Data were analyzed thematically following the Continuum of Overdose Risk. Results Most reported worsening mental health and increasing substance use during COVID-19. Isolation due to quarantining measures, coping behaviors, despair, and traumatic grief contributed to resumptions in drug use and risky behaviors. Some discussed how these stressors, combined with the rapid availability of financial resources led to increased use. Participants also attributed increased overdose risk to the increasingly toxic drug supply and stifled harm reduction access. Accounts of methadone treatment varied, however several expressed inconsistent access to take-home methadone, potentially contributing to resumed use. Conclusions Numerous micro- and macro-social factors, as well as the drug supply and treatment disruptions contributed to the acceleration in overdose risk. Increased funding and policy reform are needed to reduce overdose mortality in future public health emergencies, including improving harm reduction and treatment service adaptations to fit the needs of clients, as well as upholding and expanding novel methadone treatment delivery models.

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

The Opioid Epidemic and Perinatal Health.

As the United States grapples with an ongoing overdose crisis, states and jurisdictions are adopting novel approaches to reduce overdose mortality. In one novel approach, public health researchers and leaders in Rhode Island leveraged the state's robust surveillance data and collaborations between government, academic, and community-based organizations (CBOs) to launch the PROVIDENT (PReventing OVerdose using Information and Data from the EnvironmeNT) project, a population-based randomized controlled research trial (NCT05096429) in December 2019. The PROVIDENT trial utilizes machine learning (ML) methods to identify neighborhoods at risk of future overdose deaths at the census-block-group level to inform community-level overdose prevention resource distribution. To disseminate the ML model predictions, our research team developed an interactive, online mapping dashboard in close collaboration with three statewide CBOs. We measured whether these organizations utilized the PROVIDENT dashboard to allocate harm-reduction services based on ML model predictions and collected information about their data-driven decision-making processes. This case study describes how we assembled and piloted this overdose forecasting dashboard for use by CBOs between November 2021 and August 2024. By measuring dashboard logins, completed surveys, and engagement with ongoing training, we illustrate how organizations utilized ML and surveillance data to inform their outreach efforts and generate valuable insights at a neighborhood level.

Opioid-involved overdose mortality has been on the rise for 2 decades in the US, exacerbated by an unregulated drug supply that is unpredictable and has increasingly contained highly potent fentanyl analogs starting a decade ago. To determine whether there is a geospatial association between law enforcement drug seizures and opioid-involved overdose mortality in San Francisco. This cross-sectional study used location- and time-stamped overdose mortality data from the Office of the Chief Medical Examiner and publicly available crime data from the San Francisco Police Department between 2020 and 2023 to assess whether location and time of law enforcement drug seizures were associated with subsequent opioid-involved overdose mortality. Data were analyzed from January 2020 to September 2023. Time-stamped locations of law enforcement drug seizures involving a drug distribution charge. The primary outcomes were the time and location of (1) overdose mortality involving any opioid and (2) overdose mortality involving fentanyl or any fentanyl analog. The relative risk (RR) and 95% CIs for endemic and epidemic factors were calculated. There were 2653 drug seizure crime events that involved any drug distribution charge and 1833 overdose deaths that tested positive for any opioid or synthetic opioid, including heroin and fentanyl analogs. Within the surrounding 100 meters, law enforcement drug seizures were associated with increase risk of fatal opioid-involved overdoses the day following the drug seizure event (RR, 1.74; 95% CI, 1.06-2.83; P = .03) and elevated risk persisted for 7 days (2 days: RR, 1.55; 95% CI, 1.09-2.21; P = .02; 3 days: RR, 1.45; 95% CI, 1.08-1.93; P = .01; 7 days: RR, 1.27; 95% CI, 1.11-1.46; P = .001). Similar statistically significant spatiotemporal patterns were observed in the 250- and 500-meter spatial bandwidths. Within each space-time kernel, the strength of the association, all of which were statistically significant, dissipated the further away in time and distance from the law enforcement drug seizure event. The findings of this cross-sectional study suggest that the enforcement of drug distribution laws to increase public safety for residents in San Francisco may be having an unintended negative consequence of increasing opioid overdose mortality. To reduce overdose mortality, it may be better to focus on evidence-based health policies and interventions.

ObjectivesThe overdose crisis remains one of the largest public health issues facing North America to date. Formalized virtual spotting services have gained popularity as a harm reduction intervention, proving early effectiveness in reducing overdose mortality. This study determined the characteristics of individuals who recurrently use one such service, Canada’s National Overdose Response Service (NORS).MethodsIn this retrospective study, call logs from NORS were analyzed from service inception. Demographics including age, gender, province, community size, substance used, routes of administration, and adverse events were all collected and imputed into a marginal means and rates model to determine the predictors of recurrent service use.ResultsA total of 7340 unique calls were included within our analysis. Of those, 1167 (15.8%) reported their gender as male, 3744 (51.0%) as female, and 1329 (18.1%) as gender diverse, and 1100 (14.9%) did not report their gender. In terms of age, 46 (0.6%) were individuals under the age of 18 years, 3561 (48.5%) were between 18 and 30, 557 (7.6%) were between 31 and 40, 2505 (34.1%) were between 41 and 50, 525 (7.1%) were age 51 or over, and 146 (2.0%) did not report their age. Men’s rate ratios for recurrent calls were significantly lower than women’s (RR = 0.08, 95% CI = 0.07‒0.09), as were those for respondents aged 31‒40 years as compared with those aged 18‒30 (RR = 0.26, 95% CI = 0.15‒0.45). Between regions, rate ratios for callers from British Columbia (RR = 0.28, 95% CI = 0.17‒2.24) and Atlantic provinces (RR = 0.09; 95% CI = 0.07‒0.12) were significantly lower than those for callers from the province of Ontario. Similarly, rural callers demonstrated lower recurrent service use (RR = 0.08; 95% CI = 0.07‒0.11) than their urban counterparts.ConclusionNORS demonstrates higher usage patterns within certain demographic groups, in particular, urban women. The results can therefore be used to target public health messaging toward those who derive the most benefit from the service and to tailor programming to those who are at highest risk to use alone.

Both opioid misuse and overdose mortality have disproportionately impacted the American Indian population. Although medications for opioid use disorder, such as buprenorphine (BUP-NX), are highly effective in reducing overdose mortality, questions have been raised about the cultural acceptability of Western medical approaches in this population. Understanding patients' desired recovery pathways can lead to more culturally appropriate, patient-centered, and effective approaches to opioid use disorder (OUD) treatment. In this qualitative study, we document experiences with combined pharmacobehavioral treatment for OUD and suggestions for enhancing it. Participants (N = 45) were American Indian patients and community members impacted by OUD. They participated in one-time, 45- to 60-min, semistructured interviews. Findings from conventional content analysis indicated participants were grateful for a Tribally run combined pharmacobehavioral OUD treatment program, which made treatment more financially and geographically accessible over a large, rural area. Participants expressed satisfaction with BUP-NX and the accompanying behavioral health programming but were interested in making it more accessible through telemedicine appointments and mailed prescriptions. Participants noted the importance of clear communication about this kind of programming, which tends to be less structured than other substance-use treatment programs, but also appreciated its tailored, compassionate, and holistic approach. Participants were interested in robust counseling options; a low-barrier, acceptance-based, and harm-reduction orientation; as well as more culturally aligned programming that honored their Native heritage and traditional medicine. Treatment providers, researchers, and policymakers should consider integration of more patient-driven, compassionate, and culturally aligned means of intervention for American Indian patients with OUD. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Drug-related deaths in Italy, especially from opioid overdoses, increased by 6% among individuals aged 15-34 from 2014 to 2018. Opioid-related deaths rose by 6.6% in the 15-24 age group and by 5.4% in the 25-34 age group during this period. There is limited data on the effectiveness of different naloxone administration routes—intranasal (IN), intramuscular (IM), and intravenous (IV)—and no established guidelines for prehospital overdose management. Timely intervention is crucial to reduce overdose mortality. This review aims to assess the effectiveness of naloxone administration methods in opioid overdoses, focusing on prehospital settings and comparing IN, IM, and IV routes. A narrative review was conducted in accordance with PRISMA guidelines. The search included terms such as “naloxone,” “opioid overdose,” “intranasal administration,” and “prehospital emergency care,” with Boolean operators to refine the scope. The study selection was guided by the PICO framework (population, intervention, comparison, outcome). Studies were assessed for quality using the Dixon-Woods tool, and inclusion/exclusion criteria were applied. Studies will be selected based on populations treated with naloxone administered via intranasal, intramuscular, or intravenous routes, focusing on comparisons between these formulations in terms of onset time and intervention effectiveness. Out of 111 studies, five met the eligibility criteria. These studies showed that intranasal naloxone achieves higher plasma concentrations than intramuscular doses but with slower absorption and longer peak times. Additionally, intramuscular naloxone results in faster respiratory recovery and requires fewer doses. Intranasal naloxone has a bioavailability of 46.8% to 50.8% compared to intravenous naloxone, with efficacy outcomes varying by administration route. The review shows that intranasal naloxone, especially at a 2 mg dose, achieves plasma levels similar to intramuscular formulations and has linear pharmacokinetics across dosages. While its bioavailability is lower (46% to 50%) compared to intravenous administration, it is a safer and more practical option for non-clinical settings. Although intramuscular and intravenous routes work faster, the slower absorption of intranasal naloxone may help reduce withdrawal symptoms, supporting gradual dosing strategies. These findings emphasize the need for further research on optimizing naloxone dosing for synthetic opioid emergencies. This review highlights intravenous naloxone as the most effective route for opioid overdose treatment, with intramuscular and intranasal routes offering practical alternatives in prehospital settings. Intranasal naloxone, despite its lower bioavailability, provides a non-invasive option suitable for lay responders. Gradual dose escalation is recommended to minimize withdrawal symptoms. The increasing prevalence of synthetic opioids underscores the need for updated clinical guidelines on naloxone dosing and administration routes.

More than 50 years of high-quality data demonstrate that naloxone is an efficacious and cost-effective overdose reversal agent. Intranasal naloxone is now available in the United States as an over-the-counter and generic medication for the first time since the start of the overdose crisis more than 20 years ago. As the overdose crisis continues to contribute to substantial loss of life, there is an historic opportunity for jurisdictions to expand equitable and sustained access to intranasal naloxone. Further, through simultaneously enacting and expanding effective Naloxone Access and Good Samaritan laws, and equitably implementing these laws, there is the potential to maximize the population-level effectiveness of naloxone to sustainably reduce overdose mortality.

Opioid use disorder (OUD) is a growing public health crisis, with opioids involved in an overwhelming majority of drug overdose deaths in the United States in recent years. While medications for opioid use disorder (MOUD) effectively reduce overdose mortality, only a minority of patients are able to access MOUD; additionally, those with unstable housing receive MOUD at even lower rates. Because MOUD access is a multifactorial issue, we leverage machine learning techniques to assess and rank the variables most important in predicting whether any individual receives MOUD. We also seek to explain why persons experiencing homelessness have lower MOUD access and identify potential targets for action. We utilize a gradient boosted decision tree algorithm (specifically, XGBoost) to train our model on SAMHSA's Treatment Episode Data Set-Admissions, using anonymized demographic and clinical information for over half a million opioid admissions to treatment facilities across the United States. We use Shapley values to quantify and interpret the predictive power and influencing direction of individual features (i.e., variables). Our model is effective in predicting access to MOUD with an accuracy of 85.97% and area under the ROC curve of 0.9411. Notably, roughly half of the model's predictive power emerges from facility type (23.34%) and geographic location (18.71%); other influential factors include referral source (6.74%), history of prior treatment (4.41%), and frequency of opioid use (3.44%). We also find that unhoused patients go to facilities that overall have lower MOUD treatment rates; furthermore, relative to housed (i.e., independent living) patients at these facilities, unhoused patients receive MOUD at even lower rates. However, we hypothesize that if unhoused patients instead went to the facilities that housed patients enter at an equal percent (but still received MOUD at the lower unhoused rates), 89.50% of the disparity in MOUD access would be eliminated. This study demonstrates the utility of a model that predicts MOUD access and both ranks the influencing variables and compares their individual positive or negative contribution to access. Furthermore, we examine the lack of MOUD treatment among persons with unstable housing and consider approaches for improving access.

Evidence-based treatment for opioid use disorder is widely unavailable and often discouraged by providers of residential substance use services in North Carolina

The opioid epidemic has claimed more than 1 million lives in the United States over the past two decades. The persistent increase in deaths indicates that current strategies intended to decrease the negative consequences of opioid use are inadequate. Harm reduction strategies are designed to promote safer substance usage and reduce overdose mortality rates, yet the implementation of harm reduction programs is inhibited by community- and provider-level stigma against people who use opioids, coupled with limited understanding and insufficient education about harm reduction approaches. Despite ongoing research, engagement in opioid treatment programs remains a challenge, and the opioid crisis continues to disproportionately harm marginalized populations. This article describes how social workers are prepared to play a larger role in opioid use treatment because they are trained with the skill set and values necessary to facilitate access to harm reduction programs, promote engagement in substance use treatment, and create and advocate for interventions to address problematic substance use, especially in high-need communities.

BackgroundIn the United States, both drug overdose mortality and injection-involved drug overdose mortality have increased nationally over the past 25 years. Despite documented geographic differences in overdose mortality and substances implicated in overdose mortality trends, injection-involved overdose mortality has not been summarized at a subnational level.ObjectiveWe aimed to estimate the annual number of injection-involved overdose deaths in each US state from 2000 to 2020.MethodsWe conducted a stratified analysis that used data from drug treatment admissions (Treatment Episodes Data Set–Admissions; TEDS-A) and the National Vital Statistics System (NVSS) to estimate state-specific percentages of reported drug overdose deaths that were injection-involved from 2000 to 2020. TEDS-A collects data on the route of administration and the type of substance used upon treatment admission. We used these data to calculate the percentage of reported injections for each drug type by demographic group (race or ethnicity, sex, and age group), year, and state. Additionally, using NVSS mortality data, the annual number of overdose deaths involving selected drug types was identified by the following specific multiple-cause-of-death codes: heroin or synthetic opioids other than methadone (T40.1, T40.4), natural or semisynthetic opioids and methadone (T40.2, T40.3), cocaine (T40.5), psychostimulants with abuse potential (T43.6), sedatives (T42.3, T42.4), and others (T36-T59.0). We used the probabilities of injection with the annual number of overdose deaths, by year, primary substance, and demographic groups to estimate the number of overdose deaths that were injection-involved.ResultsIn 2020, there were 91,071 overdose deaths among adults recorded in the United States, and 93.1% (84,753/91,071) occurred in the 46 jurisdictions that reported data to TEDS-A. Slightly less than half (38,253/84,753, 45.1%; 95% CI 41.1%-49.8%) of those overdose deaths were estimated to be injection-involved, translating to 38,253 (95% CI 34,839-42,181) injection-involved overdose deaths in 2020. There was large variation among states in the estimated injection-involved overdose death rate (median 14.72, range 5.45-31.77 per 100,000 people). The national injection-involved overdose death rate increased by 323% (95% CI 255%-391%) from 2010 (3.78, 95% CI 3.33-4.31) to 2020 (15.97, 95% CI 14.55-17.61). States in which the estimated injection-involved overdose death rate increased faster than the national average were disproportionately concentrated in the Northeast region.ConclusionsAlthough overdose mortality and injection-involved overdose mortality have increased dramatically across the country, these trends have been more pronounced in some regions. A better understanding of state-level trends in injection-involved mortality can inform the prioritization of public health strategies that aim to reduce overdose mortality and prevent downstream consequences of injection drug use.

Opioid overdose deaths in the United States remain a major public health crisis. Little is known about counties with high rates of opioid overdose mortality but low availability of opioid use disorder (OUD) treatment facilities. We sought to identify characteristics of United States (US) counties with high rates of opioid overdose mortality and low rates of opioid treatment facilities. Rates of overdose mortality from 3,130 US counties were compared with availability of opioid treatment facilities that prescribed or allowed medications for OUD (MOUD), from 2018-2019. The outcome variable, "risk-availability mismatch" county, was a binary indicator of a high rate (above national average) of opioid overdose mortality with a low (below national average) rate of opioid treatment facilities. Covariates of interest included county-level sociodemographics and rates of insurance, unemployment, educational attainment, poverty, urbanicity, opioid prescribing, depression, heart disease, Gini index, and Theil index. Multilevel logistic regression, accounting for the clustering of counties within states, was used to determine associations with being a "risk-availability mismatch" county. Of 3,130 counties, 1,203 (38.4%) had high rates of opioid overdose mortality. A total of 1,098 counties (35.1%) lacked a publicly-available opioid treatment facility in 2019. In the adjusted model, counties with an additional 1% of: white residents (odds ratio, OR, 1.02; 95% CI, 1.01-1.03), unemployment (OR, 1.11; 95% CI, 1.05-1.19), and residents without insurance (OR, 1.04; 95% CI, 1.01-1.08) had increased odds of being a mismatch county. Counties that were metropolitan (versus non-metropolitan) had an increased odds of being a mismatch county (OR, 1.85; 95% CI, 1.45-2.38). Assessing mismatch between treatment availability and need provides useful information to characterize counties that require greater public health investment. Interventions to reduce overdose mortality are unlikely to be effective if they do not take into account diverse upstream factors, including sociodemographics, disease burden, and geographic context of communities.

Radical hospitality: Innovative programming to build community and meet the needs of people who use drugs at a government-sanctioned overdose prevention site in San Francisco, California

Health risks associated with smoking versus injecting fentanyl among people who use drugs in California

Background:Community advisory boards (CABs) are an established approach to ensuring research reflects community priorities. This paper examines two CABs that are part of the HEALing Communities Study which aims to reduce overdose mortality. This analysis aimed to understand CAB members’ expectations, experiences, and perspectives on CAB structure, communication, facilitation, and effectiveness during the first year of an almost fully remote CAB implementation. Current literature exploring these perspectives is limited.Methods:We collected qualitative and survey data simultaneously from members (n = 53) of two sites’ CABs in the first 9 months of CAB development. The survey assessed trust, communication, and relations; we also conducted 32 semi-structured interviews. We analyzed the survey results descriptively. The qualitative data were analyzed using a deductive codebook based on the RE-AIM PRISM framework. Themes were drawn from the combined qualitative data and triangulated with survey results to further enrich the findings.Results:CAB members expressed strong commitment to overall study goals and valued the representation of occupational sectors. The qualitative data described a dissonance between CAB members’ commitment to the mission and unmet expectations for influencing the study within an advisory role. Survey results indicated lower satisfaction with the research teams’ ability to create a mutually beneficial process, clear communication, and sharing of power.Conclusion:Building a CAB on a remote platform, within a study utilizing a community engagement strategy, still presents challenges to fully realizing the potential of a CAB. These findings can inform more effective operationalizing of community-engaged research through enhanced CAB engagement.

BackgroundOverdoses have surged in rural areas in the U.S. and globally for years, but harm reduction interventions have lagged. Overdose education and naloxone distribution (OEND) programs reduce overdose mortality, but little is known about people who use drugs’ (PWUD) experience with these interventions in rural areas. Here, we analyze qualitative data with rural PWUD to learn about participants’ experiences with an OEND intervention, and about how participants’ perceptions of their rural risk environments influenced the interventions’ effects.MethodsTwenty-nine one-on-one, semi-structured qualitative interviews were conducted with rural PWUD engaged in the CARE2HOPE OEND intervention in Appalachian Kentucky. Interviews were conducted via Zoom, audio-recorded, and transcribed verbatim. Thematic analysis was conducted, guided by the Rural Risk Environment Framework.ResultsParticipants’ naloxone experiences were shaped by all domains of their rural risk environments. The OEND intervention transformed participants’ roles locally, so they became an essential component of the local rural healthcare environment. The intervention provided access to naloxone and information, thereby increasing PWUDs’ confidence in naloxone administration. Through the intervention, over half of participants gained knowledge on naloxone (access points, administration technique) and on the criminal-legal environment as it pertained to naloxone. Most participants opted to accept and carry naloxone, citing factors related to the social environment (responsibility to their community) and physical/healthcare environments (overdose prevalence, suboptimal emergency response systems). Over half of participants described recent experiences administering intervention-provided naloxone. These experiences were shaped by features of the local rural social environment (anticipated negative reaction from recipients, prior naloxone conversations).ConclusionsBy providing naloxone paired with non-stigmatizing health and policy information, the OEND intervention offered support that allowed participants to become a part of the healthcare environment. Findings highlight need for more OEND interventions; outreach to rural PWUD on local policy that impacts them; tailored strategies to help rural PWUD engage in productive dialogue with peers about naloxone and navigate interpersonal conflict associated with overdose reversal; and opportunities for rural PWUD to formally participate in emergency response systems as peer overdose responders.Trial registration The ClinicalTrials.gov ID for the CARE2HOPE intervention is NCT04134767. The registration date was October 19th, 2019.

Pharmacists’ perceptions regarding feasibility, acceptability, and usefulness of student-delivered naloxone education services in community pharmacy: A mixed methods study in Alabama