Introduction and Overview
Who is this document for?
This document is to assist community leaders, local and regional organizers, non-profit groups, law enforcement, public health, and members of the public in understanding and navigating effective strategies to prevent opioid overdose in their communities.
How can readers use this document?
Readers can use this document as a general reference for evidence-based practices that have been successfully implemented in the U.S. and are effective in reducing rates of opioid overdose. This document also provides readers with straightforward explanations of how and why these strategies work, summaries of major research on these topics, and examples of organizations from across the U.S. that have excelled at putting these strategies into practice.
How was this document created?
The selection of evidence-based strategies included in this document began with a systematic search of scientific literature on the prevention of opioid overdose in the context of prescription opioid misuse or use of illicit opioids. To be considered for inclusion in this document, strategies must have been successfully implemented in at least one jurisdiction in the U.S. as evidence for this document was being reviewed (between April and August 2017) AND meet one of the following evidentiary criteria: (1) meta-analyses or systematic reviews have found the strategy to be effective at reducing overdose and/or factors that increase overdose risk; (2) evidence from a scientifically rigorous experimental study, such as a randomized controlled trial, demonstrates the strategy’s effectiveness in reducing overdose and/or factors that increase overdose risk; or (3) multiple observational studies from U.S. settings indicate the strategy’s ability to reduce overdose or mitigate and reduce factors that increase overdose risk. In order to provide the broadest possible
scope of evidence for guiding the implementation of overdose prevention strategies in the U.S., research that has been conducted in international settings that examines strategies also well-studied and proven feasible in U.S. settings are included in this document as well. Based on these criteria, strategies identified can be considered promising or effective in reducing opioid overdose.
Over the course of several months, researchers, public health professionals, and subject matter experts were consulted to refine the list of strategies considered into a collection of those interventions with the strongest evidence of efficacy AND with demonstrated feasibility in U.S. settings. These contributors, including physicians, epidemiologists, sociologists, medical anthropologists, harm reductionists, and more, offered individual input based on their own research and experiences working at the forefront of the opioid crisis.
This is not an exhaustive list of overdose prevention strategies. Many countries—such as Canada, Portugal, The Netherlands, Germany, Switzerland, Norway, Australia, and Uruguay, just to name a few— have implemented overdose prevention policies and programs that have never been used in the U.S. Even within the U.S., many local organizers and advocates have developed unique, locally appropriate strategies too numerous to name here.
In sum, the strategies laid out in this document are well known, evidence-based actions that U.S. states and municipalities can take today to prevent new overdoses tomorrow.
Why evidence-based?
Opioid use disorders and opioid overdose are complex phenomena shaped by numerous social, biological, and psychological factors. Due to this complexity—and the natural complexity of all human beings—fully understanding and accounting for all of these factors in an overdose prevention activity is a significant challenge. Often, ideas that once looked promising fail to pan out as expected.* There are also strategies that at first glance appeared counter-intuitive or wrong but were ultimately shown to be very effective in preventing fatal overdose. Subjecting overdose prevention interventions to scientific testing and evaluation is the only way to know for sure whether these intuitions are correct.
In acknowledgement of this pressing need, a practice is considered both “locally appropriate” and “evidence-based” if it has been designed in accordance with three key sources of information: (1) high quality scientific research; (2) the professional opinions and experiences of clinical and public health experts; and (3) the preferences, priorities, and values of the individuals who will be targeted or affected by that practice.1 By offering this summary of the current “best practices” for overdose prevention, based on a thorough review of existing research and expertise from a diverse array of medical and public health professionals, this document aims to fulfill areas 1 (scientific research) and 2 (expert opinions). Area 3, the preferences and priorities of those affected (in this case, individuals who use opioids or are otherwise at risk of opioid overdose), must be sought anew in each new community context. This combination of evidence, expertise, and community dialog will lay the groundwork for truly effective opioid overdose prevention strategies across the U.S.