Widespread naloxone distribution not enough to impact overdose death rate
UC researchers hope study helps reduce the stigma of opioid use disorder
The highest ever number of opioid-related overdose deaths in the United States was recorded in 2020 at 68,630, a 68% increase in just two years. Naloxone is a medicine that can rapidly reverse an opioid overdose, but a new study out of the University of Cincinnati finds that widespread community distribution of naloxone through a take-home naloxone (THN) program did not significantly impact the median monthly opioid overdose rates.
The study was published in PLOS ONE.
The Naloxone Distribution Collaborative (NDC) was facilitated from October 2017 through December 2019 by Hamilton County Public Health (HCPH). Opioid overdose mortality was compared between the period before (Oct. 2015-Sep. 2017) and during (Oct. 2017-Sep. 2019) the program. Prior to the start of the program, there was little distribution of THN to individuals in Hamilton County.
Caroline Freiermuth, MD, of the Department of Emergency Medicine in the UC College of Medicine/Photo/Colleen Kelley/UC Marketing + Brand
"Our goal with the naloxone distribution collaborative was to see what happens if we could saturate an entire community and see what impact that might have on the opioid overdose rates,” says Caroline Freiermuth, MD, Endowed Chair to Benefit the Acute Treatment of Mental Health and Substance Use Disorder in the Department of Emergency Medicine at the UC College of Medicine. “We looked to see what impact broad distribution of naloxone had on the community and what we found that it held opioid overdose death rates steady.”
HCPH managed naloxone inventory, recruited distribution sites and distributed cartons directly through community events and health department service locations such as a syringe service program or local jail. Partnering sites were chosen based on their interactions with persons at risk for opioid overdose, people who may interact with those at risk for opioid overdose, community involvement and willingness to participate. To be included in the study, naloxone cartons had to have documentation of either distribution to an individual from a site in Hamilton County, or distribution to an individual with a reported residence within Hamilton County.
Freiermuth says after seeing the study results showing no significant change in the opioid overdose death rate, they went back and modeled what would have happened had that level of naloxone supply been available to the community to predict the opioid death rate to be.
“If you do that prediction modeling, we would have thought the opioid death rate would keep climbing,” she says. “We saw that throughout the country and throughout Ohio, whereas here in Hamilton County we pretty much held steady. Granted there were many other things going on in our county that probably contributed to that, but we like to think that at least a piece of that was naloxone was more broadly available.”
We hope for people to ask for this medication, for people to be more aware that they may need to use it and that it’s not just homeless people or those with mental health disease who are using drugs.”
Caroline Freiermuth, MD
The THN effort in Hamilton County ended at the conclusion of 2019, and Freiermuth says the availability of naloxone has been evolving since then. Project DAWN (Deaths Avoided with Naloxone) is a network of opioid overdose education and naloxone distribution programs through the Ohio Department of Health that attempts to get naloxone out in the community as widely as possible by distributing it to community agencies who then distribute it to individuals. Plus, she says, naloxone is being made available over the counter, so that is another way people who want to have it on hand can obtain it.
The NDC was a successful effort to increase access to Narcan in the community, according to Darci Smith, director of harm reduction for HCPH.
“Increasing the amount of Narcan available in the community increases opportunities to save lives and helps reduce the stigma associated with substance use disorder and carrying Narcan,” she says. “The NDC helped lay the foundation for our current naloxone education and distribution efforts.”
With the backdrop of September being National Recovery Month, Freiermuth says one of the biggest hopes with the study is that it continues to help combat the stigma.
“There is still a lot of stigma around opioid use disorder and people who use drugs,” she says. “If you talk to people who use drugs, they don’t want to carry naloxone because there’s a stigma associated with that. It’s interesting because people will recognize that they are at risk for overdose yet still not always carry the medication because of that external symbol. We hope for people to ask for this medication, for people to be more aware that they may need to use it and that it’s not just homeless people or those with mental health disease who are using drugs.”
Lead image/Jeff Anderson/Flickr
Next Lives Here
The University of Cincinnati is classified as a Research 1 institution by the Carnegie Commission and is ranked in the National Science Foundation's Top-35 public research universities. UC's graduate students and faculty investigate problems and innovate solutions with real-world impact. Next Lives Here.
Related Stories
2021 University Recognition Ceremony honors student achievements
April 13, 2021
The University of Cincinnati recognizes students each year who have made significant service, leadership, and academic contributions to the UC community. These students exemplify the spirit of what it means to be a Bearcat.
UC Day of Giving a success
April 28, 2021
University of Cincinnati Day of Giving’s 24-hour challenge was a tremendous success this year, raising $2,219,197 with 3,232 gifts. The fourth annual UC Day of Giving raised its most money to date with alumni, donors, students, faculty and staff joining together to support UC and UC Health.
President picks exceptional talent
April 28, 2021
The University of Cincinnati 2021 Presidential Leadership Medal of Excellence Awards honor six undergraduate scholars for scholarship, leadership, character, service and the ideals of the university. Awardees are spotlighted for exceptional academics, creativity, community service and innovation.
Grad students earn president's highest honor
April 28, 2021
The University of Cincinnati 2021 Presidential Medal of Graduate Student Excellence Awards honor three graduate scholars for scholarship, leadership, character, service and the ideals of the university. Awardees are spotlighted for exceptional academics, creativity, community service and innovation.
Local 12: 180 UC med students receive white coats, students embark on journey during pandemic
August 9, 2021
The University of Cincinnati College of Medicine welcomed 180 newly admitted first-year students during the college’s 26th annual White Coat Ceremony. The ceremony was held Friday at 10 a.m. at Cincinnati Music Hall, 1241 Elm Street. Each member of the class of 2025 were presented with a white lab coat, symbolizing entry into the medical profession. Local 12 covered the event.
GIVEHOPE and BSI Engineering Celebrate Ten Years of Driving Research
August 3, 2021
Years after two personal losses from pancreatic cancer, Cincinnati-based nonprofit GIVEHOPE and consulting firm BSI Engineering are celebrating a philanthropic partnership that has funded 13 pilot research projects at the University of Cincinnati Cancer Center.
Finding community and building a future
July 9, 2021
As a University of Cincinnati College of Medicine student, Sarah Appeadu, MD, ’21, remembers journaling on the “3 Cs” that got her through medical school: Community, community, community. Now, when she lists the people who supported her through four years of training—the last year in a global pandemic—it keeps growing: her family, her church, her classmates, and the college’s Office of Student Affairs and Office of Diversity, Equity and Inclusion. “I look back and it was such a crucial time to really be nurtured in that way,” she says. “I’m so thankful that I had those people. It shows being around the right people really mattered. That’s my same hope for residency even.”
New York Times: Flint Weighs Scope of Harm to Children Caused by Lead in Water
February 1, 2016
Kim Dietrich, a professor of environmental health at UC's College of Medicine, is quoted in this story on the medical problems that could develop among the thousands of young children exposed to lead-contaminated water in Flint, Mich.
Cancer-Causing Gene Found in Plasma May Help Predict Outcomes for Patients
February 18, 2016
Researchers at the University of Cincinnati have discovered that a human cancer-causing gene, called DEK, can be detected in the plasma of head and neck cancer patients.
UC Receives $1.9 Million to Study Pain
February 15, 2016
Jun-Ming Zhang, MD, of the UC College of Medicine, is the principal investigator of a $1.95 million grant to study the interacting roles of the sympathetic and sensory nervous and immune systems in back and neuropathic pain models.