Trends and characteristics during 17 years of naloxone distribution and administration through an overdose prevention program in Pittsburgh, Pennsylvania
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Describe time trends during 17.5 years of community-based naloxone distribution. METHODS: Analysis of administrative records from a harm reduction program in Pittsburgh, Pennsylvania, USA, collected during encounters for overdose education, naloxone dispensing and refills. Monthly time trends were analyzed using segmented regression. Programmatic context aided interpretation of quantitative findings. We also evaluated impacts of 2014 state legislation loosening naloxone prescribing requirements and providing Good Samaritan protections. RESULTS: From July 2005 to January 2023 there were 16,904 service encounters by 7,582 unique participants, resulting in 70,234 naloxone doses dispensed, with 5,521 overdose response events (OREs), utilizing 8,756 naloxone doses. After legislation, new participants increased from 10.4 to 65.9 per month. New participants tended to be older (46 vs. 37 years), female (58% to 35%), White race, and more likely to be family/friends as opposed to people who use drugs themselves. Consequently, ORE per participant fell from 1.46 to 0.47 in the year after enactment. On average, 1.63 (95% CI: 1.60, 1.65) naloxone doses were administered per ORE, which did not change substantially over 17 years (χ2 = 0.28, 3 df, p = 0.60) during evolution from prescription opioids, to heroin, to illicitly manufactured fentanyl. In 98.0% of OREs the person who experienced overdose "was okay", i.e., survived. Emergency medical services were called in 16% of OREs overall, but <7% since 2019. There were 106 more emesis events per 1,000 OREs with 4 mg nasal spray compared to intramuscular injection; and 48 per 1,000 more reports of anger. Titration of intramuscular naloxone was associated with lower rates of adverse events. CONCLUSIONS: While state legislation created the environment for expansion, reaching previously underserved communities required intentional new programmatic development and outreach. Long-term consistency of <2 doses per ORE, high survival rate, and robust utilization all lend confidence in prioritizing naloxone distribution directly to people who use drugs and their social networks. Trial registration: This investigation was pre-registered https://osf.io/b2f4h.
Source: PLoS ONE
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,382
Funders: National Aeronautics and Space Administration, U.S. Department of Veterans Affairs, Bill and Melinda Gates Foundation, Welch Foundation, Texas Department of Transportation, ASCRS Research Foundation, University of Chicago, University of North Dakota, Mind Science Foundation, Fundación Séneca, Fundación Eugenio Rodríguez Pascual, Fundació la Marató de TV3, Japan Agency for Medical Research and Development, London School of Hygiene and Tropical Medicine, Wellcome Trust, Università degli Studi di Milano, Comunidad de Madrid, UK Research and Innovation, Society for the Study of Addiction, Applied Science Private University, National Cerebral and Cardiovascular Center, Cancer Research UK, Japan Society for the Promotion of Science London, Irish Research Council for Science, Engineering and Technology, Deutsche Forschungsgemeinschaft, Fundação de Amparo à Pesquisa do Estado de São Paulo, National Natural Science Foundation of China, Grantová Agentura České Republiky, Fondazione Telethon, Fondazione Cariplo, Eusko Jaurlaritza, Wissenschaftskolleg zu Berlin, Fonds Wetenschappelijk Onderzoek, Natural Science Foundation of Fujian Province, Conselho Nacional de Desenvolvimento Científico e Tecnológico, National Research Foundation of Korea, Terry Fox Research Institute, KWF Kankerbestrijding, Department of Science and Technology of Sichuan Province, Ministerio de Ciencia e Innovación, Fundação Bial, Natural Science Foundation of Chongqing, Université de Liège, Anhui Agricultural University, Fonds Léon Fredericq, Quỹ Đổi mới sáng tạo Vingroup, Natural Science Foundation of Sichuan Province, National Institutes of Health, U.S. Food and Drug Administration, Samsung, Office of Science, Federal Highway Administration, University of California, San Francisco, Horizon 2020 Framework Programme, Fred and Pamela Buffett Cancer Center, HORIZON EUROPE Framework Programme, Canadian Institutes of Health Research, Engineering and Physical Sciences Research Council, Science and Engineering Research Board, Agència de Gestió d'Ajuts Universitaris i de Recerca, Instituto de Salud Carlos III, Bijzonder Onderzoeksfonds UGent, Agencia Estatal de Investigación, National Key Research and Development Program of China, Fundamental Research Funds for the Central Universities, National Science Fund for Distinguished Young Scholars, National Safety Academic Fund, Basic and Applied Basic Research Foundation of Guangdong Province, National Heart, Lung, and Blood Institute, National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases, Fogarty International Center, Bioenergy Technologies Office, Robert Packard Center for ALS Research, Johns Hopkins University, H2020 European Research Council, NextGenerationEU
Award: G6912715671
OpenAlex ID: W4415525040