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Association of Implementation of Postoverdose Outreach Programs With Subsequent Opioid Overdose Deaths Among

Ziming Xuan^1,2, Shapei Yan³, Scott W Formica⁴

¹Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts.

JAMA Psychiatry

|March 15, 2023

Abstract

Importance:

Nonfatal opioid overdose is the leading risk factor for subsequent fatal overdose and represents a critical opportunity to reduce future overdose and mortality. Postoverdose outreach programs emerged in Massachusetts beginning in 2013 with the main purpose of linking opioid overdose survivors to addiction treatment and harm reduction services.

Objective:

To evaluate whether the implementation of postoverdose outreach programs among Massachusetts municipalities was associated with lower opioid fatality rates compared with municipalities without postoverdose outreach programs.

Design, Setting, And Participants:

This retrospective interrupted time-series analysis was performed over 26 quarters (from January 1, 2013, through June 30, 2019) across 93 municipalities in Massachusetts. These 93 municipalities were selected based on a threshold of 30 or more opioid-related emergency medical services (EMS) responses in 2015. Data were analyzed from November 2021 to August 2022.

Exposures:

The main exposure was municipality postoverdose outreach programs. Municipalities had various program inceptions during the study period.

Main Outcomes And Measures:

The primary outcome was quarterly municipal opioid fatality rate per 100 000 population. The secondary outcome was quarterly municipal opioid-related EMS response (ambulance trips) rates per 100 000 population.

Results:

The mean (SD) population size across 93 municipalities was 47 622 (70 307), the mean (SD) proportion of female individuals was 51.5% (1.5%) and male individuals was 48.5% (1.5%), and the mean (SD) age proportions were 29.7% (4.0%) younger than 25 years, 26.0% (4.8%) aged 25 to 44 years, 14.8% (2.1%) aged 45 to 54 years, 13.4% (2.1%) aged 55 to 64 years, and 16.1% (4.4%) aged 65 years or older. Postoverdose programs were implemented in 58 municipalities (62%). Following implementation, there were no significant level changes in opioid fatality rate (adjusted rate ratio [aRR], 1.07; 95% CI, 0.96-1.19; P = .20). However, there was a significant slope decrease in opioid fatality rate (annualized aRR, 0.94; 95% CI, 0.90-0.98; P = .003) compared with the municipalities without the outreach programs. Similarly, there was a significant slope decrease in opioid-related EMS response rates (annualized aRR, 0.93; 95% CI, 0.89-0.98; P = .007). Several sensitivity analyses yielded similar findings.

Conclusions And Relevance:

In this study, among Massachusetts municipalities with high numbers of opioid-related EMS responses, implementation of postoverdose outreach programs was significantly associated with lower opioid fatality rates over time compared with municipalities that did not implement such programs. Program components, including cross-sectoral partnerships, operational best practices, involvement of law enforcement, and related program costs, warrant further evaluation to enhance effectiveness.

Insights

Postoverdose outreach programs in Massachusetts were linked to a significant decrease in opioid overdose deaths over time. These programs connect overdose survivors with vital addiction treatment and harm reduction services, reducing mortality.

Area of Science:

Public Health
Epidemiology
Addiction Medicine

Background:

Nonfatal opioid overdose is a primary predictor of fatal overdose.
Postoverdose outreach programs aim to connect survivors with treatment and harm reduction services.

Purpose of the Study:

To assess the association between postoverdose outreach programs and opioid fatality rates in Massachusetts municipalities.
To compare opioid fatality rates in municipalities with and without these outreach programs.

Main Methods:

Retrospective interrupted time-series analysis of 93 Massachusetts municipalities from 2013 to 2019.
Examined quarterly opioid fatality rates and emergency medical services (EMS) response rates per 100,000 population.
Analyzed data based on the implementation of postoverdose outreach programs.

Main Results:

Implementation of postoverdose outreach programs was associated with a significant decrease in the opioid fatality rate over time.
A significant decrease was also observed in opioid-related EMS response rates.
No significant immediate change in opioid fatality rates was detected upon program implementation, but the trend decreased significantly over time.

Conclusions:

Postoverdose outreach programs are associated with reduced opioid fatality rates in municipalities with high EMS responses.
Further evaluation of program components like partnerships and law enforcement involvement is recommended.
These findings highlight the effectiveness of outreach programs in mitigating opioid-related mortality.

Read full analysis

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