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BACKGROUND: Opiate overdose continues to be a pressing public health concern across the United States. As each year more states pass legislation permitting lay individuals to carry naloxone, a lifesaving opiate antagonist, opiate-related deaths appear to decrease in those communities. However, little research exists on how nonfatal opiate overdose trends are influenced when communities establish widespread naloxone distribution. Understanding upstream effects of naloxone legislation may help support local harm reduction efforts.
METHODS: We mapped ambulance call data for opiate overdoses from July 9th, 2012-July 8th, 2014 to assess geospatial changes in distribution of nonfatal opiate overdoses from before and after initiation of lay naloxone distribution in Multnomah County, Oregon. We conducted cluster analyses to look at statistical differences from before and after the law and described the data at the census block group level for application to public health practice.
RESULTS: Preliminary results indicate there were around 25% more opiate-related calls in the year after naloxone legislation passed compared to the previous 12 months. The downtown area saw the greatest increase in calls along with other pockets throughout the county. Some regions saw reductions in calls. Additional spatial analyses are still ongoing.
CONCLUSIONS: Clusters with increased calling may suggest individuals called 911 when administering naloxone as instructed to do during their training. However, an increase in calls could also be the result of regional increase in new drug users. Historically, downtown has been a high volume location for opiate overdoses, so with an influx of new users, we would expect to see more overdoses and possibly more ambulance calls downtown. Decreased calling in specific areas may suggest individuals who carry naloxone feel confident they can save lives without medical assistance, and they therefore stop calling 911. The absence of a Good Samaritan law in Oregon may also be a disincentive for people to call 911 for an overdose when they fear prosecution for drug possession or use. Ongoing geospatial analysis of ambulance data can be used locally to help identify “hot spots” in need of localized naloxone training or other harm reduction programs. Findings may also help support preparedness and awareness training for ambulance staff. Finally, as a Good Samaritan law begins moving through the legislative process in Oregon in 2015, repeated analysis of ambulance data may help reveal the influence of such a law on opiate outcomes in the community.