Implementation and evaluation of Massachusetts' overdose education and naloxone distribution program

Since 2006, the Massachusetts Department of Public Health has supported overdose education and intranasal naloxone distribution (OEND) efforts in several community-based organizations, training potential bystanders to prevent and manage opioid overdose with intranasal naloxone. Between 2006 and 2011, over 9000 active users, people in addiction treatment, family and friends, and police officers and firefighters have been trained and over 900 overdose reversals have been reported. Trainings have been conducted in a wide variety of settings. To evaluate the impact of OEND, we compared fatal and non-fatal opioid overdose rates from town-year strata with high versus low rates of OEND implementation using Poisson regression models to estimate rate ratios adjusted for age, gender, race/ethnicity, poverty, year and access to addiction treatment services within each town. Town-year strata with high OEND enrollment had a crude opioid-related fatality rate of 12.7 per 100,000 versus 14.0 per 100,000 for town-year strata with low OEND enrollment (p=0.42). Using cumulative OEND enrollments to measure implementation, the adjusted rate ratio for fatal opioid overdose was 0.90 (95% CI: 0.73-1.12) for high versus low town-year strata. Using annual overdose reversals to measure implementation, the adjusted rate ratio for fatal overdose was 0.70 (95% CI: 0.53-0.92). No significant association was found for non-fatal overdose rates. The Massachusetts experience demonstrates that OEND can be implemented among diverse groups of potential bystanders and suggest that OEND programs decrease fatal opioid overdose rates in communities where OEND participants reverse overdoses. (Naloxone is the the treatment of choice, not a brand name)