Evaluation of a large-scale health department naloxone distribution program: Per capita naloxone distribution and overdose morality

PLOS ONE RESEARCH ARTICLE Evaluation of a large-scale health department naloxone distribution program: Per capita naloxone distribution and overdose morality Caroline E. Freiermuth ID1,2*, Rachel M. Ancona3, Jennifer L. Brown ID4, Brittany E. Punches5,6, Shawn A. Ryan1,7, Tim Ingram8,9, Michael S. Lyons6 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America, 2 Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America, 3 Department of Emergency Medicine, Washington University, St Louis, Missouri, United States of America, 4 Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, United States of America, 5 College of Nursing, The Ohio State University, Columbus, Ohio, United States of America, 6 Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States of America, 7 Brightview Health LLC, Cincinnati, Ohio, United States of America, 8 Hamilton County Public Health, Cincinnati, Ohio, United States of America, 9 Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America * OPEN ACCESS Citation: Freiermuth CE, Ancona RM, Brown JL, Punches BE, Ryan SA, Ingram T, et al. (2023) Evaluation of a large-scale health department naloxone distribution program: Per capita naloxone distribution and overdose morality. PLoS ONE 18(8): e0289959. https://doi.org/10.1371/journal. pone.0289959 Editor: Arvin Haj-Mirzaian, Massachusetts General Hospital, UNITED STATES Received: December 1, 2022 Accepted: July 30, 2023 Published: August 11, 2023 Copyright: © 2023 Freiermuth et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: There are restrictions on publicly sharing the minimal underlying dataset necessary to recreate the findings presented in this paper. This is due to the sensitive nature of the data with potentially identifying information. In addition, the information was collected under a waiver of consent from participants, granted by the IRB with the understanding that data would only be shared in aggregate form. There is not a central data access committee at the University of Cincinnati. Requests for access to the dataset will be Abstract Objectives To report per-capita distribution of take-home naloxone to lay bystanders and evaluate changes in opioid overdose mortality in the county over time. Methods Hamilton County Public Health in southwestern Ohio led the program from Oct 2017-Dec 2019. Analyses included all cartons distributed within Hamilton County or in surrounding counties to people who reported a home address within Hamilton County. Per capita distribution was estimated using publicly available census data. Opioid overdose mortality was compared between the period before (Oct 2015-Sep 2017) and during (Oct 2017-Sep 2019) the program. Results A total of 10,416 cartons were included for analyses, with a total per capita distribution of 1,275 cartons per 100,000 county residents (average annual rate of 588/100,000). Median monthly opioid overdose mortality in the two years before (28 persons, 95% CI 25–31) and during (26, 95% CI 23–28) the program did not differ significantly. Conclusions Massive and rapid naloxone distribution to lay bystanders is feasible. Even large-scale takehome naloxone distribution may not substantially reduce opioid overdose mortality rates. PLOS ONE | https://doi.org/10.1371/journal.pone.0289959 August 11, 2023 1 / 14 PLOS ONE considered on an individual basis. Any requests for data should be directed to the Early Intervention Program (EIP) via email (). This is a public health division within the department of emergency medicine. Data regarding public health programs such as this has been collected since inception of EIP in 1998. Data is stored on secured departmental servers, with no plans to archive or destroy data. Data is important to understand the impact of the public health programs and will continue to be stored indefinitely. Funding: Naloxone was supplied by Emergent BioSolutions (formerly Adapt Pharma). The company had no role in study design, data collection (other than providing information regarding naloxone prescription fills), data analysis or preparation of the manuscript. A copy of the manuscript was sent to the company after submission. Funding for this evaluation was provided through a grant from Interact for Health, a local non-profit dedicated to health equity. Some of the funds included in the grant award were supplied by Brightview LLC, a local substance use treatment facility. Funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Competing interests: Dr. Shawn Ryan serves as the chief science officer for Brightview. He was involved in the study design and the preparation of this manuscript, although he was not involved in the analysis of data. Funding for evaluation was awarded to the University of Cincinnati to fund time for CF, ML, and BP, none of whom received direct payment. Local health systems in the region funded the efforts of Hamilton County Public Health to manage the inventory and distribution efforts. Dr. Ryan was noted as having a potential competing interest, as he serves as the Chief Science Officer for Brightview. This company contributed to funding that allowed for the evaluation of this project. His involvement does not alter our adherence to PLOS ONE policies on sharing data and materials. Per capita naloxone distribution and overdose morality following a community naloxone distribution effort Introduction The highest ever number of opioid-related overdose deaths (OOD) in the U.S. was recorded in 2020 at 68,630, a 68% increase in just two years; age-adjusted synthetic OOD increased more than 1000% in the past decade to 11.4/100,000 [1, 2]. In 2017, Ohio ranked second in the United States in number of OOD, at a rate of 39.2 per 100,000 population [3]. Naloxone can rapidly reverse otherwise fatal opioid-induced respiratory depression [4]. However, the time window for efficacious administration is often less than time elapsed from overdose identification to emergency medical services arrival [5]. Community overdose education and naloxone distribution is a supported strategy to increase the chance that lay bystanders recognize an overdose victim and administer naloxone in time [6–10]. Although there are no scientific data to estimate how often a victim would survive when a bystander does not administer naloxone, survival after field administration is generally con (...truncated)