DAT18-06. Overdose deaths are increasing at alarming rates, particularly in communities affected by fentanyl; in this context, more effective and efficient strategies are urgently needed to save lives. Naloxone is an opioid antagonist that reverses an opioid overdose. Naloxone distribution to laypersons plays a crucial role in overdose rescue when there is no immediate access to first responders, or when people witnessing overdoses are unwilling or unable to call 911. There are currently two models for community naloxone distribution in the US: 1) Community-based organizations provide naloxone as part of overdose education and naloxone distribution (OEND) programs for people at risk of overdose and people in their social networks to administer naloxone. A wide variety of organizations participate, but little is known about how well different types of OEND programs reach individuals most likely to witness an overdose, as well as the cost of providing services. 2) Pharmacists in many states can dispense naloxone without an individual prescription under a standing order, and FDA is considering converting individual naloxone products to over-the counter (OTC) status. Pharmacy availability, consumer acceptance, and out-of-pocket costs vary across jurisdictions. New York City (NYC), a major urban center, and the Massachusetts (MA) and Rhode Island (RI), a multi-state region are jurisdictions with similar population sizes that have been deeply affected by the rapid increase in fentanyl-related opioid overdoses and are rapidly scaling up naloxone distribution. With populations of comparable size (NYC: 8.6 million; MA/RI: 7.9 million) they provide opportunities to explore implementation by different government authority (city with multiple boroughs vs region with multiple states) in different geographic settings using data collected at the community level. Their experience can guide jurisdictions that have less robust programs, so that these jurisdictions can avoid some of the challenges and inefficiencies encountered by the areas that scaled up early. Our interdisciplinary, highly experienced team of investigators has been working closely with government agencies and local communities in NYC and MA/RI to address the opioid overdose crisis. We propose the following research aims in collaboration with these partners: 1) estimate the impact of community- level strategies for naloxone distribution in NYC, and MA/RI on minimizing opioid overdose fatalities and optimizing allocation of available resources. We will simulate overdose impact and resource use at the local community level using mathematical models. 2) Estimate the combined impact of expanding pharmacy naloxone distribution and optimizing OEND distribution on minimizing opioid overdose fatalities in NYC and MA/RI.
This aim will be achieved by applying statistical methods to analyze pharmacy and program data. 3) Develop and test a resource allocation tool in collaboration with government agency and community partners, that can update naloxone distribution targets in response to temporal and geographic changes in the opioid overdose burden in NYC and MA/RI, with features that are relevant to other jurisdictions.

Public Health Relevance

Opioid overdose deaths are increasing at alarming rates, particularly in communities affected by fentanyl, a potent illegal opioid. To reduce the number of fatal overdoses, community-based programs and pharmacies are distributing naloxone, a life-saving drug that reverses overdoses. In this study, we will work with government agencies in New York City, and in Massachusetts/Rhode Island to determine the best local strategies to distribute naloxone in order to save the most lives and make the best use of limited resources, and we will develop a tool to support decision making in these areas and other areas with high overdose rates.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project--Cooperative Agreements (U01)
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Community Influences on Health Behavior Study Section (CIHB)
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Duffy, Sarah Q
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Weill Medical College of Cornell University
Other Health Professions
Schools of Medicine
New York
United States
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