Effects of a Naloxone ‌surges� in Ohio on Opioid Overdose Deaths

Background and purpose. Opioid overdose deaths, although seeing slight reductions in recent years, Communities continue to try and determine the best ways to reduce opioid overdoses and deaths. One strategy often discussed is “flooding” local areas with naloxone to reach populations most at risk for overdoses and overdose deaths. The effects of this strategy have not yet been tested. In 2021, Ohio implemented two surges. The first targeted 89 zip codes at high risk for overdose deaths in May 2021 (e.g., targeted surge). The second made naloxone available to any organization in the state who asked in August/September 2021 (e.g., blitz surge). We examined whether these surges resulted in fewer opioid overdoses and deaths across Ohio. During this same time period, nineteen Ohio counties were part of the HEALing Communities Study, a non-blinded randomized controlled trial (RCT)designed to significantly reduce opioid overdose death. The RCT was in the middle of the measurement period comparing Wave 1 to Wave 2 when these surges were implemented.Thus, we also examine how these surges were related to overdoses in these communities.

Methods. Monthly overdose death data were provided by the Ohio Department of Health for 2018-2022. Data were analyzed with a generalized linear model interrupted time series using a negative binomial distribution, that accounted for seasonal, pre-COVID and COVID trends in the data. We included indicators for the May and August surges and a time*intervention variable to account for the fact that naloxone kits might not have been used in the same month they were given to potential users.

Results. The average naloxone distribution rate was 780.3 per 100,000 residents for the targeted intervention and 290.7 per 100,000 residents during the blitz intervention compared to a baseline of 182.8 per 100,000 residents in the state. The targeted intervention surge was associated with a 14% decrease (RR=0.86, p=0.04) in overdose deaths, but the time*intervention effect was not significant. The blitz surge was not associated with an immediate decrease in overdose deaths but was related to a significant time*intervention effect decreasing deaths by 0.5% (RR=0.97, p=0.001) each month beginning in September 2021. Counties involved in the Healing Communities Study only had a significant time*intervention effect for the August surge, a decrease of 0.9% per month (RR=0.96, p=0.02) for Wave 1 communities only.

Conclusions and Implications. The targeted intervention distributed 2.69 times the naloxone than the blitz strategy and 4.27 times that distributed in 2020. Targeting naloxone to community members who are likely to be a victim of or witness an overdose and first responders (e.g., police, Emergency Medical Services) appears to be a cost-effective strategy at reducing opioid overdose deaths. There are immediate policy considerations based on the finding of these naloxone distribution efforts. Funding for Ohio’s harm reduction efforts, including naloxone, have been supported by the federal government; however, these funds are not unlimited. Here we demonstrate the need to continue a strategic distribution plan to target geographic areas where people are most at-risk for overdose.