Overdose education and nasal naloxone distribution (OEND) programmes can reduce mortality rates from opioid overdose, a study from the USA has shown.

A controlled observational study of the implementation of OEND programmes was carried out in communities with a high prevalence of opioid overdose in Massachusetts. Communities with little or no OEND enrollment served as controls.

In OEND programmes those at risk of opioid overdose together with their families and friends are trained to recognise overdose, call help, provide respiratory support and administer nasal naloxone to anyone suspected of having an opioid overdose.

The researchers analysed opioid overdose related deaths and acute care admissions in both study and control communities between 2002 and 2009.

Between 2006 and 2009 almost 3,000 people in the study communities underwent OEND training, and they reported 327 rescues over this time period.

Observed mortality and acute admissions in study and control areas were adjusted for a range of demographic and other factors.

There was a reduction in mortality from opioid overdose in the study areas compared with controls. Both community-year strata with 1-100 enrollments per 100,000 population, adjusted rate ratio RR 0.73 (95% CI:0.57-0.91) and community-year strata with more than 100 enrollments per 100,000 population, adjusted rate ratio RR 0.54 (95% CI:0.39-0.76) had significantly reduced rate ratios for annual deaths related to opioid overdose compared with communities with no implementation.

However, there was no significant difference in the rates of acute admissions between the groups.

The incidence of death from fatal overdose of opioids has increased in recent years in the USA, and this has gone hand in hand with increases in opiate-related A&E attendance and hospital admission. These developments have been paralleled by growth in opioid analgesic prescribing and illicit opioid use.

There have been more than 10,000 opioid overdose rescues since the programme started in the mid-1990s.

Opioid overdose mortality is very high in the USA, related in part to high levels of opioid analgesic prescribing. This study shows that deaths caused by overdose can be reduced with public education, training and the provision of rescue kits containing nasal naloxone.

Dr Jez Thompson

• Walley AY, Xuan Z, Hackman HH et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ 2013;346:f174