Community-based Overdose Prevention and Naloxone Prescription Program in Pittsburgh/Allegheny County

Accidental overdose fatalities are a serious concern for the public health community. Between 1980 and 1990, there was an average of 58 overdose fatalities per year in Allegheny County. This number increased to 100 overdose fatalities reported in 1998 and has increased since, peaking in 2007 with 253 overdose fatalities before declining slightly to 240 in 2010. In response to increasing overdose fatalities in the region, Prevention Point Pittsburgh (PPP) created an Overdose Prevention Program (OPP) in 2002 with the goal of developing and implementing practical strategies to reduce overdose deaths, complementing existing drug prevention and treatment efforts. In 2005 the OPP began distributing Narcan/naloxone to people at risk for overdose. The paper's aims are to (1) chart the development and implementation of the OPP, including barriers and obstacles we faced, with a focus on the opportunities presented and the response from program participants, and (2) assess the outcomes of the program. We describe the experiences of 639 individuals who participated in the OPP between July 1, 2005 and December 31, 2010. Of these, naloxone was administered in response to an overdose in 468 separate overdose episodes. We provide a description of these overdose episodes, including drugs involved and outcomes. We also discuss participant characteristics, commonly held “myths” of overdose prevention strategies among participants, and the major obstacle of fear of police involvement and arrest when participants respond to an overdose.