{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:17:48Z","timestamp":1790176668771,"version":"4.1.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Many US states are substantially increasing community-based naloxone distribution, supported in part through settlements from opioid manufacturers and distributors.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To evaluate the potential impact of increased naloxone availability on opioid overdose deaths (OODs) and explore strategies to enhance this impact by integrating interventions to address solitary drug use.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This decision analytical modeling study used PROFOUND (Prevention and Rescue of Fentanyl and Other Opioid Overdoses Using Optimized Naloxone Distribution Strategies), a previously published simulation model, to forecast annual OODs between January 2023 and December 2025. The simulated study population included individuals from Rhode Island who misused opioids and stimulants and were at risk for opioid overdose.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n The study modeled expanded naloxone distribution supported by the state\u2019s opioid settlement (50\u202f000 naloxone nasal spray kits each year). Two approaches to expanding naloxone distribution were evaluated: one based on historical spatial patterns of naloxone distribution (supply-based approach) and one based on the spatial distribution of individuals at risk (demand-based approach). In addition, hypothetical interventions to enhance the likelihood of witnessed overdoses in private or semiprivate settings were considered.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Annual number of OODs and ratio of fatal to nonfatal opioid overdoses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Modeling results indicated that distributing more naloxone supported by the state\u2019s opioid settlement could reduce OODs by 6.3% (95% simulation interval [SI], 0.3%-13.7%) and 8.8% (95% SI, 1.8%-17.5%) in 2025 with the supply-based and demand-based approaches, respectively. However, increasing witnessed overdoses by 20% to 60% demonstrated greater potential for reducing OODs, ranging from 8.5% (95% SI, 0.0%-20.3%) to 24.1% (95% SI, 8.6%-39.3%). Notably, synergistic associations were observed when combining both interventions: increased naloxone distribution with the 2 approaches and a 60% increase in witnessed overdoses could reduce OODs in 2025 by 33.5% (95% SI, 17.1%-50.4%) and 37.4% (95% SI, 19.6%-56.3%), respectively.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n These findings suggest that interventions to address solitary drug use are needed to maximize the impact of continued efforts to increase community-based naloxone distribution, which may be particularly important for jurisdictions that have strong community-based naloxone distribution programs.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.13861","type":"journal-article","created":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T11:34:43Z","timestamp":1717068883000},"page":"e2413861","source":"Crossref","is-referenced-by-count":29,"title":["Evaluation of Strategies to Enhance Community-Based Naloxone Distribution Supported by an Opioid Settlement"],"prefix":"10.1001","volume":"7","author":[{"given":"Xiao","family":"Zang","sequence":"first","affiliation":[{"name":"Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Skinner","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell S.","family":"Krieger","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Czarina N.","family":"Behrends","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medical College, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju N.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Traci C.","family":"Green","sequence":"additional","affiliation":[{"name":"The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Y.","family":"Walley","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake R.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin P.","family":"Linas","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts"},{"name":"Department of Medicine, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse L.","family":"Yedinak","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce R.","family":"Schackman","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medical College, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon D. L.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,5,30]]},"reference":[{"issue":"6","key":"zoi240475r1","first-page":"523","article-title":"Accelerated overdose deaths linked with COVID-19.","volume":"325","author":"Kuehn","year":"2021","journal-title":"JAMA"},{"issue":"10","key":"zoi240475r4","first-page":"64","article-title":"Fentanyl and fentanyl analogs detected among unintentional opioid involved overdose deaths in Rhode Island: January 2019\u2013December 2021.","volume":"105","author":"Weidele","year":"2022","journal-title":"R I Med J (2013)"},{"issue":"2","key":"zoi240475r5","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1046\/j.1360-0443.1999.9421993.x","article-title":"Preventing opiate overdose fatalities with take-home naloxone: pre-launch study of possible impact and acceptability.","volume":"94","author":"Strang","year":"1999","journal-title":"Addiction"},{"issue":"3","key":"zoi240475r6","doi-asserted-by":"publisher","first-page":"e210","DOI":"10.1016\/S2468-2667(21)00304-2","article-title":"Estimating naloxone need in the USA across fentanyl, heroin, and prescription opioid epidemics: a modelling study.","volume":"7","author":"Irvine","year":"2022","journal-title":"Lancet Public Health"},{"issue":"11","key":"zoi240475r7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.41174","article-title":"Comparing projected fatal overdose outcomes and costs of strategies to expand community-based distribution of naloxone in Rhode Island.","volume":"5","author":"Zang","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"35","key":"zoi240475r12","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.15585\/mmwr.mm6935a1","article-title":"Vital signs: characteristics of drug overdose deaths involving opioids and stimulants\u201424 states and the District of Columbia, January\u2013June 2019.","volume":"69","author":"O\u2019Donnell","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"22","key":"zoi240475r13","doi-asserted-by":"publisher","first-page":"12073","DOI":"10.3390\/ijerph182212073","article-title":"Peer support and overdose prevention responses: a systematic \u2018state-of-the-art\u2019 review.","volume":"18","author":"Mercer","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"zoi240475r14","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103820","article-title":"The estimated costs and benefits of a hypothetical supervised consumption site in Providence, Rhode Island.","volume":"108","author":"Chambers","year":"2022","journal-title":"Int J Drug Policy"},{"issue":"7","key":"zoi240475r15","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1001\/jamapsychiatry.2023.0546","article-title":"Overdose detection technologies\u2014a new frontier in preventing solitary drug overdose deaths.","volume":"80","author":"Park","year":"2023","journal-title":"JAMA Psychiatry"},{"issue":"10","key":"zoi240475r18","first-page":"62","article-title":"Accidental drug overdose deaths in Rhode Island: January 1, 2016\u2013July 31, 2020.","volume":"103","author":"Hallowell","year":"2020","journal-title":"R I Med J (2013)"},{"issue":"2","key":"zoi240475r19","first-page":"41","article-title":"Identification and description of non-fatal opioid overdoses using Rhode Island EMS data, 2016\u20132018.","volume":"102","author":"Lasher","year":"2019","journal-title":"R I Med J (2013)"},{"issue":"7","key":"zoi240475r21","first-page":"25","article-title":"State unintentional drug overdose reporting surveillance: opioid overdose deaths and characteristics in Rhode Island.","volume":"101","author":"Jiang","year":"2018","journal-title":"R I Med J (2013)"},{"issue":"1","key":"zoi240475r23","doi-asserted-by":"publisher","first-page":"66","DOI":"10.3109\/09687637.2014.981509","article-title":"Take-home naloxone to prevent fatalities from opiate-overdose: protocol for Scotland\u2019s public health policy evaluation, and a new measure to assess impact.","volume":"22","author":"Bird","year":"2015","journal-title":"Drugs (Abingdon Engl)"},{"issue":"3","key":"zoi240475r24","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1111\/add.v114.3","article-title":"Dying alone: the sad irrelevance of naloxone in the context of solitary opiate use.","volume":"114","author":"Wojcicki","year":"2019","journal-title":"Addiction"},{"issue":"5","key":"zoi240475r25","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1111\/add.v118.5","article-title":"Safety in solitude? competing risks and drivers of solitary drug use among women who inject drugs and implications for overdose detection.","volume":"118","author":"Rosen","year":"2023","journal-title":"Addiction"},{"issue":"13","key":"zoi240475r26","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1080\/10826084.2020.1790008","article-title":"\u201cWhen you\u2019re getting high\u2026 you just don\u2019t want to be around anybody\u201d: a qualitative exploration of reasons for injecting alone: perspectives from young people who inject drugs.","volume":"55","author":"Winiker","year":"2020","journal-title":"Subst Use Misuse"},{"issue":"1","key":"zoi240475r27","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/s12954-022-00723-4","article-title":"Prevalence and correlates of using opioids alone among individuals in a residential treatment program in Michigan: implications for overdose mortality prevention.","volume":"19","author":"Gicquelais","year":"2022","journal-title":"Harm Reduct J"},{"issue":"1","key":"zoi240475r28","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s12954-020-00436-6","article-title":"Convenience and comfort: reasons reported for using drugs alone among clients of harm reduction sites in British Columbia, Canada.","volume":"17","author":"Papamihali","year":"2020","journal-title":"Harm Reduct J"},{"issue":"1","key":"zoi240475r29","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s12954-024-00933-y","article-title":"Using alone at home: what\u2019s missing in housing-based responses to the overdose crisis?","volume":"21","author":"Fleming","year":"2024","journal-title":"Harm Reduct J"},{"issue":"1","key":"zoi240475r30","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1177\/00220426231151377","article-title":"Injecting alone: the importance of perceived safety, stigma and pleasure for solitary injecting.","volume":"54","author":"Hanoa","year":"2024","journal-title":"J Drug Issues"},{"key":"zoi240475r32","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2023.104121","article-title":"Virtual overdose monitoring services and overdose prevention technologies: opportunities, limitations, and future directions.","volume":"119","author":"Rioux","year":"2023","journal-title":"Int J Drug Policy"},{"key":"zoi240475r33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108387","article-title":"Differential impacts of COVID-19 across racial-ethnic identities in persons with opioid use disorder.","volume":"129","author":"Mistler","year":"2021","journal-title":"J Subst Abuse Treat"},{"key":"zoi240475r34","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103923","article-title":"Increased solitary drug use during COVID-19: an unintended consequence of social distancing.","volume":"111","author":"Schneider","year":"2023","journal-title":"Int J Drug Policy"},{"key":"zoi240475r9","volume-title":"Equitable Solutions","author":"Krawczyk","year":"2023"},{"key":"zoi240475r2","unstructured":"National Institute on Drug Abuse. Drug overdose death rates. Accessed March 26, 2023. https:\/\/nida.nih.gov\/research-topics\/trends-statistics\/overdose-death-rates#:~:text=Overall%2C%20drug%20overdose%20deaths%20rose,overdose%20deaths%20reported%20in%202021"},{"key":"zoi240475r3","unstructured":"KFF. Opioid overdose death rates and all drug overdose death rates per 100,000 population (Age-Adjusted). Accessed March 26, 2024. https:\/\/www.kff.org\/other\/state-indicator\/opioid-overdose-death-rates\/"},{"key":"zoi240475r8","unstructured":"Rhode Island Department of Health. See the data. Accessed March 26, 2023. https:\/\/preventoverdoseri.org\/see-the-data\/"},{"key":"zoi240475r10","unstructured":"Teva Announces Nationwide Opioids Settlement to Move Forward After Receiving Broad Support from States. January 9, 2023. Accessed March 26, 2023. https:\/\/www.tevapharm.com\/news-and-media\/latest-news\/teva-announces-nationwide-opioids-settlement-to-move-forward-after-receiving-broad-support-from-states\/"},{"key":"zoi240475r11","unstructured":"Executive Office of Health and Human Services State of Rhode Island. Opioid Settlement Advisory Committee. Accessed March 26, 2023. https:\/\/eohhs.ri.gov\/Opioid-Settlement-Advisory-Committee"},{"key":"zoi240475r16","unstructured":"Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health: 2-Year RDSA (2018-2019). Accessed March 5, 2021. https:\/\/datatools.samhsa.gov\/"},{"key":"zoi240475r17","unstructured":"US Census Bureau. Social Explorer Tables (SE). Accessed April 9, 2022. https:\/\/www.socialexplorer.com\/"},{"key":"zoi240475r20","unstructured":"Rhode Island Department of Health. SUDORS Data: bystander presence and response during accidental and undetermined drug overdose deaths in Rhode Island, 2016\u20132021. 2022. Accessed April 20, 2023. https:\/\/ridoh-drug-overdose-surveillance-fatalities-rihealth.hub.arcgis.com\/documents\/presentation-sudors-data-bystander-presence-and-response-during-accidental-and-undetermined-drug-overdose-deaths-in-rhode-island-2016-2021\/explore"},{"key":"zoi240475r22","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2021. Accessed December 21, 2021. https:\/\/www.R-project.org\/"},{"key":"zoi240475r31","unstructured":"Drug Policy Alliance. Overdose Prevention Centers (OPCs) (Deep Dive). Accessed May 20, 2023. https:\/\/drugpolicy.org\/no-one-should-die-from-overdose-overdose-prevention-centers-save-lives\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2819204\/zang_2024_oi_240475_1715972699.64459.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T11:34:55Z","timestamp":1717068895000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2819204"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,30]]},"references-count":34,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.13861","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,30]]}}}