Variation in knowledge and attitudes among overdose prevention collaborations: Insights from fatality review teams

Overdose fatality review (OFR) teams use cross-sector case review to develop prevention recommendations. We examined whether members' overdose knowledge and attitudes toward methadone, buprenorphine, and harm reduction differed by institutional domain.

We analyzed cross-sectional survey data from 145 members of 18 Indiana OFR teams, classified as public health, treatment/recovery/social support (TRSS), or criminal-legal system (CLS). Outcomes included a modified 11-item Brief Opioid Overdose Knowledge questionnaire, 7-point medication effectiveness and acceptability ratings, and Harm Reduction Acceptability Scale scores, for which higher scores indicated less favorable attitudes. One-way ANOVAs with Tukey-adjusted comparisons assessed domain differences.

Mean knowledge clustered near the maximum (9.3 of 11) and total and subscale scores did not differ by domain. Public health and TRSS respondents rated methadone (mean differences, 1.50 and 1.19) and buprenorphine (1.79 and 1.06) more effective than CLS respondents (all p < 0.01). Public health respondents rated methadone (1.26, p = 0.02) and buprenorphine (1.29, p < 0.01) more acceptable. CLS respondents reported less favorable harm reduction attitudes than public health and TRSS respondents (differences, 10.69 and 12.47; p = 0.02 and p < 0.01, respectively).

Among Indiana OFR members, institutional domain was associated with medication and harm reduction attitudes, but not measured overdose knowledge. The null knowledge finding warrants caution given the apparent ceiling effect. Domain-specific concerns merit consideration in cross-sector implementation efforts.