Background Opioid overdose is a major and increasing cause of injury and death. There is an urgent need for interventions to reduce overdose events among high-risk persons.
Methods Adults at elevated risk for opioid overdose involving heroin or pharmaceutical opioids who had been cared for in an emergency department (ED) were randomised to overdose education combined with a brief behavioural intervention and take-home naloxone or usual care. Outcomes included: (1) time to first opioid overdose-related event resulting in medical attention or death using competing risks survival analysis; and (2) ED visit and hospitalisation rates, using negative binomial regression and adjusting for time at risk.
Results During the follow-up period, 24% of the 241 participants had at least one overdose event, 85% had one or more ED visits and 55% had at least one hospitalisation, with no significant differences between intervention and comparison groups. The instantaneous risk of an overdose event was not significantly lower for the intervention group (sub-HR: 0.83; 95% CI 0.49 to 1.40).
Discussion These null findings may be due in part to the severity of the population in terms of housing insecurity (70% impermanently housed), drug use, unemployment and acute healthcare issues. Given the high overdose and healthcare utilisation rates, more intensive interventions, such as direct referral and provision of housing and opioid agonist treatment medications, may be necessary to have a substantial impact on opioid overdoses for this high-acuity population in acute care settings.
Trial registration number NCT0178830; Results.
- behavior change
- health education
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Contributors CJB-G, POC, JOM, CD, DMD, NDY and ASF substantially contributed to the conception and design of the study. CJB-G, ASF, JMS and LKW also contributed to acquiring data. All authors were involved in analysis and interpretation of the data, drafting and revising the article and provided final approval of the submitted manuscript.
Funding Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under award number 1R01A030351. Study data were collected and managed using REDCap electronic data capture tools hosted at the Institute of Translational Health Sciences. REDCap at ITHS is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1 TR002319.
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Competing interests POC has previously directed National Institutes of Health-funded trials that have received donated study medications from Alkermes (2014–2015) and Gilead (2015–2017).
Ethics approval University of Washington Human Subjects Division and Washington State Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
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