HealthDay News — A state-sponsored program focusing on opioid overdose education and nasal naloxone distribution effectively reduced opioid-related overdose deaths in Massachusetts, results of an observational study indicate.

Communities that implemented opioid overdose education and nasal naloxone distribution (OEND) programs reported fewer opioid-related overdose deaths, with greater reductions observed in communities that trained more people, Alexander Y. Walley, MD, from the Boston University School of Medicine, and colleagues reported in BMJ.

High-implementing communities (more than 100 enrollments per 100,000 population), had an adjusted rate ratio of 0.54 (95% CI: 0.39-0.76) opioid-related deaths per year, whereas low-implementing communities (100 or fewer  per 100,000 population) had an aRR of 0.73 (95% CI: 0.57- 0.91), the researchers found.

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The findings persisted after adjusting for demographics, utilization of addiction treatment and doctor shopping (schedule II opioid prescriptions from ≥4 prescribers and filled prescriptions at ≥4 pharmacies in a 12 month period).

“This study provides strong support for the public health agency policy and community-based organization practice to implement and expand OEND programs as a key way to address the opioid overdose epidemic,” the researchers wrote.

Poisoinings, the majority of which are related to opioid drug overdoses, have surpassed motor vehicle accidents as the leading cause of preventable deaths in the United States. To determine the effect of state-supported OEND programs, Walley and colleagues analyzed rates of opioid-linked overdose mortality and acute care utilization in 19 Massachusetts communities with high overdose burdens from 2002 to 2009.

OEND programs consisted of distributing nasal naloxone rescue kits to those at risk for overdose and potential bystanders — social service agency staff, and family and friends of opioid users —  and training them to prevent, recognize, and respond to an overdose.

None of the 19 participating communities had any OEND implementation from 2002 to 2005, seven had some implementation in 2006 (three enrollees per 100,000 population), 14 had some in 2007 (seven enrollees per 100,000), and all had OEND implementation in 2008 to 2009 (medians of 55 and 142, respectively).

A total of 2,912 potential bystanders were trained and 327 rescues performed during the study period.

Despite reduced adjusted rate ratios for annual deaths related to opioid overdose in communities with OEND programs compared with those without, there were no significant differences in the rates of acute care hospital utilization, the researchers found.

“While OEND programs should reduce visits to emergency departments and hospital admissions by preventing overdoses in the first place, they may also increase visits by encouraging bystanders to engage the emergency medical system, which is an explicit part of OEND curriculums,” the researchers hypothesized.

The majority of rescue attempts — 87% — were initiated by the opioid user, and occurred in private settings. Among rescue attempts initiated by a bystander, the bystander was usually a friend of the user.

Among the 153 rescue attempts that used naloxone, 98% were successful (n=150). For the three rescue attempts where naloxone was not successful, the people who overdosed received care from emergency medical services and survived.

Due to the observational nature of the study, the results do not definitely prove that OEND programs caused a reduction in opioid related overdose death rates, the researchers acknowledged.

Study limitations included lack of information regarding the true population of opioid users in each community, potential misclassification of opioid overdose fatalities, use of administrative discharge codes to estimate ED and hospital admissions associated with opioid poisoning and the potential for underreporting of overdose rescue attempts.


  1. Walley AY et al. BMJ. 2013; 346: f174.