Characteristics of post-overdose outreach programs and municipal-level opioid overdose in Massachusetts

Simeon D Kimmel; Ziming Xuan; Shapei Yan; Audrey M Lambert; Scott W Formica; Traci C Green; Jennifer J Carroll; Sarah M Bagley; David Rosenbloom; Leo Beletsky; Alexander Y Walley

doi:10.1016/j.drugpo.2023.104164

Characteristics of post-overdose outreach programs and municipal-level opioid overdose in Massachusetts

Int J Drug Policy. 2023 Oct:120:104164. doi: 10.1016/j.drugpo.2023.104164. Epub 2023 Sep 13.

Authors

Affiliations

¹ Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States; Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States. Electronic address: simeon.kimmel@bmc.org.
² Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown Building - 4th Floor, Boston, MA 02118, United States.
³ Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States.
⁴ AHOPE, Department of Recovery Services, Boston Public Health Commission, 774 Albany St, Boston, MA 02118, United States.
⁵ Social Science Research and Evaluation, Inc, 84 Mill Street, Lincoln, MA 01773, United States.
⁶ Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 024537, United States; Department of Medicine, Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, United States; COBRE on Opioids and Overdose at Rhode Island Hospital, 1125 North Main St., Providence, RI 02904, United States.
⁷ Department of Medicine, Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, United States; Department of Sociology and Anthropology, North Carolina State University, Raleigh, NC, United States.
⁸ Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, 801 Albany St, Boston, MA 02118, United States.
⁹ Department of Health, Law, Policy and Management, Boston University School of Public Health, 348W, 715 Albany Street, Boston, MA 02118, United States.
¹⁰ Northeastern University School of Law, Bouvé College of Health Sciences, and The Action Lab, 416 Huntington Ave, Boston, MA 02115, United States; Division of Global Public Health and Infectious Diseases, University of California, San Diego School of Medicine, 9500 Gillman Drive, La Jolla, CA 92093, United States.

PMID: 37713939
DOI: 10.1016/j.drugpo.2023.104164

Abstract

Background: Post-overdose outreach programs have proliferated in response to opioid overdose. Implementing these programs is associated with reductions in overdose rates, but the role of specific program characteristics in overdose trends has not been evaluated.

Methods: Among 58 Massachusetts municipalities with post-overdose outreach programs, we examined associations between five domains of post-overdose outreach program characteristics (outreach contact rate, naloxone distribution, coercive practices, harm reduction activities, and social service provision or referral) and rates of fatal opioid overdoses and opioid-related emergency medical system responses (i.e., ambulance activations) per calendar quarter from 2013 to 2019 using segmented regression analyses with adjustment for municipal covariates and fixed effects. For both outcomes, each domain was modeled: a) individually, b) with other characteristics, and c) with other characteristics and municipal-level fixed effects.

Results: There were no significant associations (p < 0.05) between outreach contact rate, naloxone distribution, coercive practices, or harm reduction activities with municipal fatal overdose trends. Municipalities with programs providing or referring to more social services experienced 21% fewer fatal overdoses compared to programs providing or referring to more social services (Rate Ratio (RR) 0.79, 95% Confidence Interval (CI) 0.66-0.93, p = 0.01). Compared to municipalities in quarters when programs had no outreach contacts, municipalities with some, but less than the median outreach contacts, experienced 14% lower opioid-related emergency responses (RR 0.86, 95% CI 0.78-0.96, p = 0.01). Associations between naloxone distribution, coercive practices, harm reduction practices, or social services and opioid-related emergency responses were not consistently significant across modeling approaches.

Conclusion: Municipalities with post-overdose outreach programs providing or referring to more social services had lower fatal opioid overdose rates. Municipalities in quarters when programs outreached to overdose survivors had fewer opioid-related emergency responses, but only among programs with below the median number of outreach contacts. Social service linkage should be core to post-overdose programs. Evaluations should assess program characteristics to optimize program design.

Keywords: Harm reduction; Law enforcement; Opioids; Overdose prevention; Post-overdose outreach.