Details:

Alternative Title:
Inj Prev
Personal Author:
Alexandridis, Apostolos A ; McCort, Agnieszka ; Ringwalt, Christopher L ; Sachdeva, Nidhi ; Sanford, Catherine ; ... More +
Alexandridis, Apostolos A ; McCort, Agnieszka ; Ringwalt, Christopher L ; Sachdeva, Nidhi ; Sanford, Catherine ; Marshall, Stephen W ; Mack, Karin ; Dasgupta, Nabarun Less -
Description:
Background

In response to increasing opioid overdoses, US prevention efforts have focused on prescriber education and supply, demand and harm reduction strategies. Limited evidence informs which interventions are effective. We evaluated Project Lazarus, a centralised statewide intervention designed to prevent opioid overdose.

Methods

Observational intervention study of seven strategies. 74 of 100 North Carolina counties implemented the intervention. Dichotomous variables were constructed for each strategy by county-month. Exposure data were: process logs, surveys, addiction treatment interviews, prescription drug monitoring data. Outcomes were: unintentional and undetermined opioid overdose deaths, overdose-related emergency department (ED) visits. Interrupted time-series Poisson regression was used to estimate rates during preintervention (2009–2012) and intervention periods (2013–2014). Adjusted IRR controlled for prescriptions, county health status and time trends. Time-lagged regression models considered delayed impact (0–6 months).

Results

In adjusted immediate-impact models, provider education was associated with lower overdose mortality (IRR 0.91; 95% CI 0.81 to 1.02) but little change in overdose-related ED visits. Policies to limit ED opioid dispensing were associated with lower mortality (IRR 0.97; 95% CI 0.87 to 1.07), but higher ED visits (IRR 1.06; 95% CI 1.01 to 1.12). Expansions of medication-assisted treatment (MAT) were associated with increased mortality (IRR 1.22; 95% CI 1.08 to 1.37) but lower ED visits in time-lagged models.

Conclusions

Provider education related to pain management and addiction treatment, and ED policies limiting opioid dispensing showed modest immediate reductions in mortality. MAT expansions showed beneficial effects in reducing ED-related overdose visits in time-lagged models, despite an unexpected adverse association with mortality.


Subjects:
[+]
Analgesics, Opioid Article Drug Overdose Emergency Service, Hospital Guideline Adherence Harm Reduction Humans Patient Education As Topic Practice Guidelines As Topic Practice Patterns, Physicians' Prescription Drugs Program Evaluation
Source:
Inj Prev. 24(1):48-54
Pubmed ID:
28835443
Pubmed Central ID:
PMC5795575
Document Type:
Journal Article
Funding:
CC999999/Intramural CDC HHS/United States ; U01 CE002162/CE/NCIPC CDC HHS/United States
CC999999/Intramural CDC HHS/United States ; U01 CE002162/CE/NCIPC CDC HHS/United States Less -
Place as Subject:
North Carolina
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:097cfd05c4bd3e59aef715e57b233b03f6d69faa9d905666f0c7a8c108faebbb
Download URL:
https://stacks.cdc.gov/view/cdc/51416/cdc_51416_DS1.pdf
File Type:

Supporting Files

• 	NIHMS933912-supplement-Supplemental.pdf	pdf
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