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Written by Brittni Reilly and MaryKate Duska of the Bureau of Substance Addiction Services

The overdose crisis in Massachusetts takes a significant toll on communities. Since 2016, Massachusetts has lost approximately 2,000 lives a year to overdose deaths. The increased presence of fentanyl in the drug supply has been a key driver of the increase in overdose death across the Commonwealth. In the first half of 2020, the rate of fentanyl present among opioid-related overdose deaths where a toxicology report was available was 93 percent. Due to the potency and fast action of fentanyl, trained community members with access to naloxone is a key public health strategy for reducing overdose death in Massachusetts.

NPHW alternate imageBuilding off of the success of community-based overdose prevention and naloxone distribution pilots, DPH launched the Overdose Education and Naloxone Distribution (OEND) Program in 2007. The OEND program is a targeted intervention designed for people who are the highest risk of experiencing or witnessing an overdose. OEND programs operate under the model of harm reduction. Harm reduction practitioners work with people who use drugs to develop individualized strategies that reduce risk and celebrate any positive change. The program aims to support people who use drugs and their social networks with overdose prevention education and to equip them with naloxone so they can save lives in the community. The OEND program has demonstrated through data that with access to education and resources, community members who use drugs can practice harm reduction and save lives.

Today, the OEND program is offered by 23 agencies, with 35 locations. The programs operate out of Syringe Services Programs and other community-based organizations that offer fixed sites, mobile services, and street outreach. Since 2007, the OEND program has trained and provided naloxone to over 99,000 unique individuals and over 29,000 rescues have been reported to OEND program staff. Several studies have been completed using the OEND program data. Their results have demonstrated a number of positive results of the program. Communities where naloxone rescue kits are distributed have lower rates of opioid overdose death. Naloxone rescue kits distribution is feasible among people in methadone maintenance programs. Naloxone rescue kits are used successfully to save lives by both people who are trained and not trained. Finally, families of people who use opioids are an important group to equip with naloxone rescue kits.

While the OEND program is focused on people who use drugs and individuals at escalated risk for overdose, DPH has also promoted broad access to naloxone through the pharmacy through public health communications campaigns. Since 2018, naloxone has been available in all MA pharmacies to individuals without a prescription via the statewide standing order.

DPH also operates the Municipal Naloxone Bulk Purchasing program, available to all communities in MA. Since 2016, over 180 municipal police and fire departments and over 75 health departments, school districts, community colleges, and sheriff’s departments have participated in the program. Since the program’s inception, over 117,000 doses of naloxone have been purchased at a significant discount. Since 2015, DPH has operated the First Responder Naloxone Grant. This grant supports 33 municipal police and fire departments in high-incident cities and towns to offset costs related to overdose response and naloxone.

Prevention and Education. DPH has developed a landing page for all things naloxone: This page links to many resources, including ones that describe how to prevent, identify, and respond to opioid overdoses. The Opioid Overdose Risk Factors page includes information on factors that can increase a person’s risk of overdosing, and offers harm reduction strategies for preventing overdoses. This resource also provides basic information about fentanyl.

The How to Reverse an Overdose page provides a step-by-step guide on how to identify and respond to an opioid overdose. The guide explicitly instructs the reader on 1) how to recognize and overdose, 2) calling 911, 3) how to administer naloxone or Narcan, 4) how to provide rescue breathing, and 5) what to do until help arrives. It also provides tips on what to do if you have to leave before help arrives, and what to expect when responding to an overdose involving fentanyl.

Opioid overdose deaths are preventable. Distributing this information and promoting access to naloxone is key to a successful public health approach to reduce opioid-related fatalities. This knowledge can equip people with the resources to save lives and strengthen communities throughout the state.

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