Opioid Overdose Prevention Programs May Reduce Deaths

Community opioid overdose prevention programs (OOPPs) - including the use of naloxone (Narcan) for rapid drug reversal - can improve bystander responses to overdose of heroin and related drugs, according to a study published in the June issue of the Journal of Addiction Medicine.

There is growing interest in OOPPs to fight the rising number of deaths from overdose of opioids, including heroin and prescription painkillers. In these programs, kits containing naloxone are distributed directly to patients at risk for overdose. Naloxone kits and training are often delivered in conjunction with needle exchange programs.

Christine M. Wilder, University of Cincinnati School of Medicine, Cincinnati, Ohio, and colleagues identified and analysed the results of 19 published studies evaluating OOPPs. The training programs included recognition, prevention, and risk factors for overdose; and how to respond to an overdose, including naloxone administration. Naloxone was usually given by injection, but sometimes by nasal administration.

Fourteen studies provided follow-up data on more than 9,000 OOPP participants. Nearly half of patients participating in OOPP programs had experienced an overdose during their lifetime, and about 80% had witnessed an overdose.

Eighteen studies provided data on nearly 1,950 naloxone administrations. When naloxone was given in response to an overdose, the person giving it was usually also an opioid user.

Eleven studies reported 100% survival; the rest reported survival rates of 83% to 96%. Two studies provided data suggesting that OOPPs were associated with community-wide reductions in opioid overdose deaths. The studies also provided information on 12 unsuccessful administrations, in which naloxone did not reverse the overdose for various reasons.

Community-Based Opioid Overdose Prevention Programs Providing Naloxone - United States, 2010 Drug overdose death rates have increased steadily in the United States since 1979. In 2008, a total of 36,450 drug overdose deaths (i.e., unintentional, intentional [suicide or homicide], or undetermined intent) were reported, with prescription opioid analgesics (e.g., oxycodone, hydrocodone, and methadone), cocaine, and heroin the drugs most commonly involved. Since the mid-1990s, community-based programs have offered opioid overdose prevention services to persons who use drugs, their families and friends, and service providers. Since 1996, an increasing number of these programs have provided the opioid antagonist naloxone hydrochloride, the treatment of choice to reverse the potentially fatal respiratory depression caused by overdose of heroin and other opioids. Naloxone has no effect on non-opioid overdoses (e.g., cocaine, benzodiazepines, or alcohol). In October 2010, the Harm Reduction Coalition, a national advocacy and capacity-building organization, surveyed 50 programs known to distribute naloxone in the United States, to collect data on local program locations, naloxone distribution, and overdose reversals. This report summarizes the findings for the 48 programs that completed the survey and the 188 local programs represented by the responses. Since the first opioid overdose prevention program began distributing naloxone in 1996, the respondent programs reported training and distributing naloxone to 53,032 persons and receiving reports of 10,171 overdose reversals. Providing opioid overdose education and naloxone to persons who use drugs and to persons who might be present at an opioid overdose can help reduce opioid overdose mortality, a rapidly growing public health concern.