Outreach program after opioid overdose decreases later overdose death

Key takeaways:

• Municipalities with post-opioid overdose outreach programs had a lower risk for later overdose death.
• Future research should identify program components that contribute to these differences.

Participation in an outreach program following a nonfatal opioid overdose was associated with lower risk for later overdose death, according to data published in JAMA Psychiatry.

“In the 12 months ending in April 2021, there were 75,673 opioid deaths, mostly associated with fentanyl’s presence in the illicit drug supply,” Ziming Xuan, ScD, SM, a professor in the department of community health sciences at the Boston University School of Public Health, and colleagues wrote of the U.S. opioid crisis.

Expanded access to naloxone and medications for opioid use disorder, as well as expansion of drug monitoring programs and institution of Good Samaritan laws have been among the methods used to address opioid overdose, according to study background.

“In Massachusetts, municipalities began implementing post-overdose outreach programs in 2013,” the researchers wrote. “Despite their proliferation, post-overdose programs have not been rigorously evaluated.”

Xuan and colleagues evaluated the rate of opioid overdose deaths per quarter from 2013 to June 30, 2019, in 93 Massachusetts municipalities that had at least 30 opioid-related emergency medical services (EMS) responses in 2015. There were 58 (62%) municipalities with outreach programs by the second quarter of 2019.

Overall, the municipalities included for analyses accounted for 66% of Massachusetts’ population and 78% of the state’s fatal opioid overdoses. Except for a higher methadone admission rate in municipalities without an outreach program (P = .02), there were no differences in baseline characteristics between municipalities with and without post-overdose programs. During the second quarter of 2019, EMS response rates were lower in municipalities with an outreach program compared with no program (P = .02).

Implementation of an outreach program was not associated with a significant change in the opioid fatality rate. However, there was a significant change in slope (annualized adjusted RR = 0.94; 95% CI, 0.9-0.98), corresponding with an annual decrease of 0.43 (95% CI, –0.79 to –0.07) in opioid fatalities per 100,000 people.

Additionally, opioid EMS response rates decreased significantly in municipalities with outreach programs, with the annual response rate decreasing by 5.14 (95% CI, –9.96 to –0.32) per 100,000 people.

“Given heterogeneity in program components and implementation as well as other contemporaneous programs that may have been in effect within municipalities, further research is needed to understand possible contributions of these various components and related program costs to the findings,” Xuan and colleagues wrote.