INPEDE OD Study
Ziming Xuan, MA, ScD, Biostatistician
Christine Chaisson, MPH, Co-Investigator
Al Ozonoff, PhD, Co-Investigator
Holly Hackman, MD, MPH, Co-Investigator
Amy Sorensen-Alawad, Program Manager
Maya Doe-Simkins, Public Health Consultant
Emily Quinn, Data Manager
From 1999 to 2005, the number of unintentional poisoning deaths in the United States, 94% of which were due to drug overdoses, almost doubled from 12,186 to 23,618. This growth in fatal overdose has been driven by substantial growth in opioid analgesic prescriptions, increasing nonmedical use of prescription opioids, and increasing availability of low cost, high purity heroin. In Massachusetts from 1990 to 2006, annual opioid-related poison fatalities increased over six-fold from 94 to 637. Abuse of prescription opioid pain relievers can directly cause overdose when used alone or in combination with street drugs, such as heroin. Abuse of prescription drugs also can serve as a gateway to heroin use which carries a high risk of overdose, particularly in places where heroin is affordable and readily accessible.
One novel approach to opioid overdose prevention is overdose education with naloxone distribution (OEND) programs. Implemented by community-based HIV risk reduction agencies or public health agencies over the last decade in parts of Europe and North America, these programs outreach to people likely to be bystanders during an overdose and educate them on how to prevent an overdose from occurring and how to prevent a non-fatal overdose from progressing to a fatal overdose. These programs train potential bystanders how to use naloxone – a prescription medication with no abuse potential that immediately reverses an opioid overdose and is part of the standard emergency medical response to a suspected opioid overdose. From 1999 through 2007, over 20,000 potential bystanders have been trained by OEND programs in North America resulting in over 2500 opioid overdoses reversed with naloxone. An OEND program began in Boston in September of 2006 and after 15 months had trained 385 potential bystanders and documented 74 successful overdose reversals. Based on the Boston program, in December of 2007, the Massachusetts Department of Public Health (MDPH) expanded OEND to include 8 sites throughout the commonwealth, which as of November of 2008 had trained an additional 1,600 potential bystanders and documented over 200 additional overdose reversals.
While OEND programs in Massachusetts have been implemented in several of the communities with the highest burden of opioid overdose, there are some high burden communities where OEND programs have not been implemented. Thus, the implementation of OEND programs in Massachusetts creates the opportunity for us to study the programs’ impact on fatal and non-fatal overdose rates, using those communities where OEND has not been implemented for comparison. Multiple studies have demonstrated the feasibility of OEND programs, yet an impact on overdose rates has not been demonstrated.
The INPEDE OD Study will achieve the following specific aim:
Specific Aim: Determine the impact of opioid overdose education with intranasal naloxone distribution (OEND) public health programs in Massachusetts on fatal and non-fatal opioid overdose rates.
In achieving this aim, this study will test the following hypotheses:
Hypothesis 1: Among Massachusetts communities with high burdens of opioid overdose, the implementation of OEND programs from 2006 to 2009 is associated with decreased rates of fatal opioid overdose.
Hypothesis 2: Among Massachusetts communities with high burdens of opioid overdose, the implementation of OEND programs from 2006 to 2009 is associated with decreased rates of non-fatal opioid overdose.