Naloxone reduces community-level opioid overdose mortality

Alex Walley and colleagues have published their analysis of the Massachusetts naloxone program, which shows what I'm going to call a per capita dose-dependent reduction in opioid overdose death (rate ratio of 0.73 [95%CI 0.57-0.91] if naloxone was given to 1-100 people per 100,000 population and 0.54 [0.39-0.76] for naloxone to >100/100,000). This provides the first real community-level effectiveness data to-date.

The finding that naloxone was more effective the more people per population were given kits suggests that aggressive distribution may be the optimal approach for naloxone programs. This study doesn't answer the question as to why there was a dose-dependent response - was it simply because more is better? were there social network effects where naloxone became substantially more effective if it reached into certain social networks, which was more likely if it was more widely distributed? Social network issues have yet to be explored in overdose prevention research.

Family members get involved in OD prevention

by Maya Doe-Simkins

Overdose education and naloxone distribution (OEND) has fundamentally changed the way that harm reduction service providers and friends and family of drug users interact -- it is a “game changer.”  

Syringe exchanges, for example, have often (though definitely not always) had a tenuous relationship with loved ones of drug users -- there is a very acute response to knowing that you are frantically doing everything you can think of to entice your child/partner/family member to stop injecting heroin and find “recovery,” while someone at an exchange is giving that person clean needles, cookers, tourniquets, filters. Public health practitioners acknowledge the two events can and should happen in tandem. Some loved ones find solace in knowing that needle exchange workers are taking care of their loved ones with supplies and seeing them for the wonderfully complex people they are -- but there is no denying that it is intense to know that there are people out there handing out injection equipment to a person whose potential abstinence consumes so much of your time and energy.

Enter take home naloxone. Families and friends of drug users are acutely aware of the lurking possibility of overdose -- I met one woman who went to three wakes in one week. Possessing naloxone gives loved ones a reprieve from the nagging fear and allows people to breathe a little more easily.  What parents and family members have done with the extra breath is talk -- to local health service organizations, local, state and federal elected officials, the police, the media, each other, the drug users they care about, pharmaceutical manufacturing companies, grant making organizations, and importantly organizations that provide harm reduction services. 

In Massachusetts, “non-users” (friends/family/service providers) approached syringe exchange and drop in programs that were providing OEND services to train them -- in church basements, around the kitchen table, etc. In recognizing that training this group of people is different than training drug users about overdose, a “Friends & Family” curriculum was developed. (Curriculum and accompanying power point can be downloaded here.)  

But that wasn’t enough -- fierce and vocal family members themselves wanted to be able to participate in spreading the training and materials to save lives.  A parent group, Learn To Cope, has been approved to be trainers & some members now provide overdose education and naloxone in addition to the practical, logistical and emotional support that they had been offering families.  

This graph, presented to the FDA in April 2012, shows the breakdown of “users” (self- identified current or ever) and “non-users” enrolled in four years at various sites -- about 1/3 of the people who get trained in Massachusetts to recognize overdose and administer naloxone are “non-users”.  Parents, other family, and friends of drug users are incredible advocates for better overdose prevention programs.

The Quincy Police Department: Pioneering Naloxone Among First Responders.

By Leo Beletsky, Elena Moroz

In Massachusetts, opioid overdose is the leading cause of accidental fatality; it ranks third overall behind heart disease and cancer. In this state, 60% of all poisoning deaths are due to opioid overdoses. Communities just outside of Boston, including Quincy and Lynn have been particularly hard-hit. These areas have three times more heroin-related ER visits than the rest of the country. Heroin, not alcohol, is the most common substance of abuse in Abington, Quincy and Weymouth. Other opioids besides heroin are also abused more frequently in New England than any other region of the United States.

In response to the rising number of opiate overdoses in the area over the past 10 years, the Massachusetts Department of Public Health (MDPH) launched a program to facilitate bystander intervention. The Overdose Education and Naloxone Distribution (OEND) program has reached out to thousands of drug users, their caregivers and other members of the community, distributing naloxone and authorizing bystander administration. The program has also expanded to training non-medical first responders, including fire fighters and police, after a group of drug users’ parents, advocated for increased police involvement in the program.

Nancy is the mother of Brendan, who was a college-bound honor student and an athlete at Boston College High School. It was a shock to everyone when Brendan developed an addiction to his father’s pain medication – OxyContin. The addiction lead Brendan to heroin, homelessness, problems with the law and finally a near-fatal overdose event. Kathy’s son Michael also found his way to opioid addiction through painkillers. When Michael suffered a motorcycle accident, he became addicted to Vicodin and later transitioned to heroin, also surviving an overdose.