ArticleBMJ (Clinical research ed.)2013
Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis.
Article in BMJ (Clinical research ed.), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 495 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
495 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Evidence-based consensus guidelines for the pharmacological management of substance dependence: Recommendations from the British Association for Psychopharmacology.Journal of psychopharmacology (Oxford, England) · 2026Guideline
- Part 4: Systems of Care: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation · 2025Guideline
- Effectiveness of naloxone distribution in community settings to reduce opioid overdose deaths among people who use drugs: a systematic review and meta-analysis.BMC public health · 2025Pooled it
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2022Guideline
- Management of opioid use disorder and associated conditions among hospitalized adults: A Consensus Statement from the Society of Hospital Medicine.Journal of hospital medicine · 2022Pooled it
- How do naloxone-based interventions work to reduce overdose deaths: a realist review.Harm reduction journal · 2022Pooled it
- Recruiting a National Sample of First Response Agencies to Participate in an Overdose Prevention Research Project: Randomized Controlled Trial and Feasibility Study.JMIR formative research · 2026Trial
- Organizational perspectives on the impacts of scaling up overdose education and naloxone distribution in Kentucky.Addiction science & clinical practice · 2025Trial
- Effect of the Communities That HEAL Intervention on Overdose Education and Naloxone Distribution: A Cluster-Randomized, Wait-List Controlled Trial.American journal of public health · 2025Trial
- Take-home naloxone in multicentre emergency settings: the TIME feasibility cluster RCT.Health technology assessment (Winchester, England) · 2024Trial
- Take-home naloxone administered in emergency settings: feasibility of intervention implementation in a cluster randomized trial.BMC emergency medicine · 2024Trial
- Reducing perceived barriers to scaling up overdose education and naloxone distribution and medications for opioid use disorder in the United States in the HEALing (Helping End Addiction Long-Term®) communities study.Preventive medicine · 2024Trial
- Organize and mobilize for implementation effectiveness to improve overdose education and naloxone distribution from syringe services programs: a randomized controlled trial.Implementation science : IS · 2024Trial
- Trial
- A randomized clinical trial of the effects of brief versus extended opioid overdose education on naloxone utilization outcomes by individuals with opioid use disorder.Drug and alcohol dependence · 2022Trial
- The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention targeting opioid use disorder: A pilot randomized clinical trial.Journal of substance abuse treatment · 2022Trial
- Emotional reactions of trained overdose responders who use opioids following intervention in an overdose event.Substance abuse · 2022Trial
- Using naloxone saturation measures and opioid overdose burden to optimize geographic distribution of naloxone in Rhode Island.Journal of substance use and addiction treatment · 2026Article
- Socioenvironmental disasters and the dialectics of overdose mortality.The International journal on drug policy · 2026Article
- Meeting people where they are, whenever they are here: the implementation of harm reduction programs in two U.S. emergency departments.International journal of emergency medicine · 2026Article
435 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
objectiveTo evaluate the impact of state supported overdose education and nasal naloxone distribution (OEND) programs on rates of opioid related death from overdose and acute care utilization in Massachusetts.
designInterrupted time series analysis of opioid related overdose death and acute care utilization rates from 2002 to 2009 comparing community-year strata with high and low rates of OEND implementation to those with no implementation.
setting19 Massachusetts communities (geographically distinct cities and towns) with at least five fatal opioid overdoses in each of the years 2004 to 2006.
participantsOEND was implemented among opioid users at risk for overdose, social service agency staff, family, and friends of opioid users.
interventionOEND programs equipped people at risk for overdose and bystanders with nasal naloxone rescue kits and trained them how to prevent, recognize, and respond to an overdose by engaging emergency medical services, providing rescue breathing, and delivering naloxone.
main outcome measuresAdjusted rate ratios for annual deaths related to opioid overdose and utilization of acute care hospitals.
resultsAmong these communities, OEND programs trained 2912 potential bystanders who reported 327 rescues. Both community-year strata with 1-100 enrollments per 100,000 population (adjusted rate ratio 0.73, 95% confidence interval 0.57 to 0.91) and community-year strata with greater than 100 enrollments per 100,000 population (0.54, 0.39 to 0.76) had significantly reduced adjusted rate ratios compared with communities with no implementation. Differences in rates of acute care hospital utilization were not significant.
conclusionsOpioid overdose death rates were reduced in communities where OEND was implemented. This study provides observational evidence that by training potential bystanders to prevent, recognize, and respond to opioid overdoses, OEND is an effective intervention.
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