How Might We Do More to Reduce Opioid Overdose Deaths?

Despite increased attention and dedication of resources, the U.S. opioid epidemic continues to generate significant increases in overdose deaths with no sign of decline. The age-adjusted opioid overdose mortality rate increased more than five times in the United States from 1999 through 2015. In 2016, the largest annual increase in overdose mortality was recorded, fueled partly by heroin laced with fentanyl—a synthetic opioid 25–50 times more potent than heroin.

Opioid overdose deaths can be prevented with naloxone, a Food and Drug Administration (FDA)-approved medication that safely reverses opioid-related overdoses. However, for naloxone to be effective, it must be administered within a certain timeframe. Overdoses can be reversed by paramedics or law enforcement; however, transportation time for emergency services can cause delays that are fatal. Additionally, 911 calls for help by people who use drugs or who are bystanders can be delayed or do not occur due to mistrust of authorities, fears of discrimination, or fears of prosecution.

Overdose education and naloxone distribution (OEND) programs train laypersons to act as responders in overdose events, providing a real-time response by allowing other people who use drugs, family members, or peers to administer naloxone and prevent a fatal outcome. A strong body of research supports the effectiveness and cost-effectiveness of OEND programs to reduce overdose deaths. Given the increase of fentanyl in the heroin supply, these programs are growing in importance as fentanyl-related overdose can occur within seconds to minutes, resulting in a shortened response window for naloxone to be effective.

Although the number of programs has increased by 243% from 2010 through 2014, a cross-sectional study that I conducted with others reveals strikingly low levels of OEND programs throughout the United States, even in counties with the highest overdose mortality rates. Shockingly, the study found that only 8% of U.S. counties had OEND programs by 2014 and 13% of counties with the highest overdose mortality rates had OEND programs.

These results highlight a critical gap in the implementation of OEND programs, even in the areas that could benefit the most from them. Implementation science is one research field that can catalyze our understanding of how to address this gap. According to National Institutes of Health, implementation science is the “scientific study of the use of strategies to adopt and integrate evidence-based health interventions into clinical and community settings in order to improve patient outcomes and benefit population health.” Investigations along these lines need to consider the reasons why OEND programs lag behind the increasing demand, the strategies that can catalyze OEND program implementation in various service settings, and the mechanisms and possible adaptations of those strategies in different settings.