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

Abstract

ImportanceNonfatal 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.ObjectiveTo 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 ParticipantsThis 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.ExposuresThe main exposure was municipality postoverdose outreach programs. Municipalities had various program inceptions during the study period.Main Outcomes and MeasuresThe 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.ResultsThe 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 RelevanceIn 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.

Interrupted Time Series Analysis of Bar/Tavern Closing Hours and Violent Crime

“…We performed the ITS using Poisson regression with overdispersion adjustment through a scale parameter and used logtransformed land area (square miles) as an offset. 25 The modeling sequence followed 3 steps. Model 1 was an unadjusted base model.…”

“Wanna cry this out real quick?”: an examination of secondary traumatic stress risk and resilience among post-overdose outreach staff in Massachusetts

“…In summary, the larger study identified 157 post-overdose outreach programs that were operating in Massachusetts prior to July 2019. A detailed survey completed by 138 of these programs was used to characterize their components (e.g., team composition, outreach approach, services provided) [ 4 ] and to explore associations between the presence of these programs and subsequent reductions in opioid overdose deaths [ 6 ]. The qualitative aim of the larger study involved conducting semi-structured interviews with 38 post-overdose outreach team members at 11 of these programs to further explore patterns observed in the quantitative data related to the implementation of these programs [ 8 , 9 ].…”

“…These programs provide a range of services including referral to and navigation of addiction treatment systems, recovery support, overdose prevention education and naloxone distribution, and support for families and social networks of overdose survivors [ 5 ]. Implementation of these programs has been associated with lower rates of fatal opioid overdose at the municipal level [ 6 ], but the operational pathways through which they operate is not well understood [ 7 ] – including critical questions concerning whether incorporating law enforcement officers into outreach activities increases overdose survivors’ risk of arrest and other adverse outcomes [ 8 – 12 ]. Independent of team composition and team members’ background and training, post-overdose outreach work can cause mental stress among team members due to their close interactions with overdose survivors and families who have recently experienced a life-threatening event [ 13 – 15 ].…”

RREACT: A mobile multidisciplinary response to overdose

“…First responders ( firefighters, EMS providers, law enforcement (LE) officers) may represent an under-utilized resource for connecting high-risk patients to OUD treatment, as they are oftentimes the only providers who have contact with individuals following an overdose, particularly when patients decline transportation to an ED or live in an "opioid treatment desert" (Allen et al, 2021;Cao et al, 2019;Centers for Disease Control and Prevention National Center for Injury Prevention and Control, 2021;Hyder et al, 2021). Thus, programs that leverage first responders' access to patients to provide harm reduction and connection to recovery resources may increase the chances of long-term recovery after an overdose (Diriba & Whitlock, 2022;Langabeer et al, 2020;Wagner et al, 2019;Xuan et al, 2023). Preliminary reports suggest that mobile multidisciplinary teams are effective in providing proactive outreach and harm reduction to these patients; however, little is known about program design and outcomes (Bagley et al, 2019;Langabeer et al, 2020;Xuan et al, 2023).…”

“…Thus, programs that leverage first responders' access to patients to provide harm reduction and connection to recovery resources may increase the chances of long-term recovery after an overdose (Diriba & Whitlock, 2022;Langabeer et al, 2020;Wagner et al, 2019;Xuan et al, 2023). Preliminary reports suggest that mobile multidisciplinary teams are effective in providing proactive outreach and harm reduction to these patients; however, little is known about program design and outcomes (Bagley et al, 2019;Langabeer et al, 2020;Xuan et al, 2023).…”