Evaluating the Impact of an Integrated Street Medicine Team's Naloxone Distribution Efforts: An Interrupted Time Series Design

Background: There has been acceleration of opioid overdose (OD) deaths following the onset of the COVID-19 pandemic. Naloxone remains the safest and most accessible intervention for laypersons to combat opioid ODs in their communities. Persons experiencing homelessness carry a higher risk of fatal opioid ODs compared to the general population. However, significant barriers to naloxone uptake persist, especially among groups who experience significant health inequities and have minimal to no resources. Limited studies have examined the impact of integrated street medicine teams, which include social workers, on community naloxone distribution efforts on naloxone saturation and fatal and nonfatal opioid OD rates.

Methods: Over a 37-month period beginning in December 2019, community partners in Bakersfield engaged in naloxone distribution efforts and completed an associated naloxone distribution program form for each recipient (n = 1,054) in selected zip codes. A local integrated street medicine began distributing naloxone to unsheltered people who were experiencing homelessness during rounds beginning May 2021. Using an interrupted time series design, we compared the number of naloxone kits distributed, the number of reported OD reversals, and fatal and nonfatal opioid ODs in the selected zip codes pre- and post-implementation of the integrated street medicine team’s naloxone training and distribution efforts.

Results: The integrated street medicine team’s naloxone distribution efforts were associated with a significant 10.44% reduction (95% CI – 19.96 to – 0.91, p = 0.023) in fatal opioid OD deaths. However, there was not a significant effect on the total number of naloxone kits distributed, reported total opioid OD (fatal and nonfatal), and reported successful opioid OD reversals by laypersons.

Conclusions: As street medicine teams establish trust and rapport with unsheltered people who are experiencing homelessness, they are able to provide lifesaving training and access to naloxone among a medically underserved population with a high likelihood of witnessing or experiencing an OD event. Naloxone distribution efforts embedded in integrated street medicine teams stand to increase naloxone saturation, enhance health equity, and decrease fatal opioid ODs among people who are unhoused. The integration of social workers into street medicine teams warrants further attention and research.