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

Autor:	Xuan Z; Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts.; Boston University School of Public Health, Department of Epidemiology, Boston, Massachusetts., Yan S; Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston, Massachusetts., Formica SW; Social Science Research and Evaluation, Inc, Lincoln, Massachusetts., Green TC; The Heller School for Social Policy and Management at Brandeis University, Institute for Behavioral Health, Waltham, Massachusetts.; Brown University, Department of Medicine, Providence, Rhode Island., Beletsky L; Northeastern University School of Law, Bouvé College of Health Sciences, and The Action Lab, Boston, Massachusetts.; University of California San Diego, School of Medicine, Division of Infectious Disease and Global Public Health, La Jolla., Rosenbloom D; Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, Massachusetts., Bagley SM; Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston, Massachusetts.; Boston Medical Center and Boston University School of Medicine, Department of Pediatrics, Division of General Pediatrics, Boston, Massachusetts., Kimmel SD; Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston, Massachusetts.; Boston Medical Center and Boston University School of Medicine, Department of Medicine, Section of Infectious Diseases, Boston, Massachusetts., Carroll JJ; Brown University, Department of Medicine, Providence, Rhode Island.; North Carolina State University, Department of Sociology and Anthropology, Raleigh., Lambert AM; AHOPE, Boston Public Health Commission, Boston, Massachusetts., Walley AY; Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	JAMA psychiatry [JAMA Psychiatry] 2023 May 01; Vol. 80 (5), pp. 468-477.
DOI:	10.1001/jamapsychiatry.2023.0109
Abstrakt:	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.
Databáze:	MEDLINE
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