Assessing the implementation of opioid overdose education and naloxone distribution in Massachusetts: The Intranasal Naloxone and Prevention EDucation's Effect on OverDose (INPEDE OD) Study

Background: In Massachusetts from 1990 to 2006, growth in opioid prescriptions, nonmedical use of opioids, and heroin availability drove a six-fold increase (94 to 637) in annual opioid-related fatal overdoses. In 2006, the Massachusetts Department of Public Health implemented overdose education and intranasal naloxone distribution (OEND) in 8 established community-based organizations. These organizations train potential bystanders on how to reduce overdose risk, recognize signs of overdose, access emergency medical services, and administer intranasal naloxone. Methods: To assess implementation, we used data collected from each enrollee and reported overdose reversal. Forms provided demographics, zip codes of residence and overdose, overdose history, overdose circumstances, substance use, and medical care utilization. To determine impact we will measure changes in fatal and non-fatal overdose rates from 2002 through 2009 in the 18 Massachusetts communities with highest numbers of opioid overdoses. The primary comparisons will be between communities where OEND programs were implemented and communities where they were not, using an interrupted time series analysis. Results: From 2006 through 2009, more than 4000 potential bystanders have been trained and over 500 opioid overdose reversals documented. Two thirds of the trainees were active drug users. Active users had high rates of polysubstance use, previous overdose, and witnessing overdose. Almost half of non-users (friends, families, professionals) had witnessed a previous overdose. Significance: Massachusetts OEND programs have reached high-risk active users and non-users who have witnessed previous overdose. The INPEDE OD Study will determine the impact of OEND programs on fatal and non-fatal opioid overdose rates in Massachusetts.