Community-based investigations of prescription opioid overdose outbreaks: Findings and responses from a three-site rapid assessment and response study

Background: Drug poisonings are the leading cause of adult accidental death in Rhode Island and Connecticut, with unprecedented involvement of prescription opioid medications. This study aimed to better understand prescription opioid overdose deaths at a community level and derive prevention options. Methods: We selected three locations in Connecticut and Rhode Island with the highest rates and counts of prescription opioid overdose. Qualitative and quantitative data were gathered by field teams over 12 weeks, guided by local advisory boards. Interviews recruited state and local officials, prescribers, pharmacists, emergency services, drug treatment providers, police, and community-level informants including people with personal knowledge of prescription opioid abuse or overdose. Brief surveys elicited responses from people recruited from health centers, drug treatment, and bars. Descriptive statistics summarized quantitative data; interviews were transcribed and coded thematically to identify potential causes of fatal overdose. Advisory boards reviewed findings and selected responses for preventive interventions. Results: 146 interviews and 51 brief surveys were collected. Identified causes of overdose included accessibility of opioid medications; limited drug treatment, especially medication-assisted treatment (MAT); difficulties coordinating care for patients with chronic pain, chronic disease(s), and substance use disorders; poor knowledge of opioid overdose symptoms; community-level denial; stigmatization of drug use and of pain management; and fear of calling 911. Implemented responses involve public awareness campaigns, community Naloxone distribution, medication drop boxes, MAT provision, safer prescribing toolkits, prescription monitoring program education for health providers, and policy change. Conclusions: Multi-faceted causes of prescription opioid overdose necessitate demand, supply, harm reduction, and structural responses.