Efforts To Reduce Overdose Deaths

As reported in our recent article, which found an association between expansion of methadone and buprenorphine treatment and the reduction in heroin overdose deaths in Baltimore, Maryland, between 1995 and 2009, the distribution of the opioid antagonist naloxone is one of a number of public health strategies being employed in the United States and United Kingdom (among other countries) to reduce opioid overdose deaths.1–4 From 2004 through 2009, the office of the Baltimore City Health Commissioner led an overdose prevention education and naloxone distribution (OPEND) program (J. M. S served as the Health Commissioner during part of that period). The OPEND program was initially funded by a foundation’s Drug Addiction Treatment Program (led by R. P. S.), and was inspired by the Chicago Recovery Alliance’s pioneering overdose prevention program. The program taught drug-addicted individuals and their significant others to identify the symptoms of overdose, to call 911, to provide rescue breathing, and, if available, to inject naloxone while waiting for an ambulance. It is likely that some of the decrease in opioid overdose deaths since the OPEND program was initiated in 2004 was the result of this program’s operation. As noted in our report and in the letter by Sherman et al., approximately 200 to 300 naloxone vials were distributed per year—a relatively modest number. However, Sherman et al. rightly point out that a much larger number of individuals were trained to identify and respond to overdose symptoms, despite not having access to naloxone. We commend the Baltimore City Health Department for having sustained and expanded this life-saving program over the past decade. We wholeheartedly agree with Sherman et al. that expanded access to pharmacotherapy for opioid use disorders (in the community and in jails) and to programs like OPEND should play an important role in comprehensive efforts to reduce mortality from opioid overdoses.