In 2017, the Centers for Disease Control and Prevention announced drug overdose mortality hit a record high, with 70,237 Americans dying from overdose.(1) The impact of the contemporary overdose crisis is felt heavily in Florida: Opioid-related deaths increased 35% between 2015 and 2016 statewide(2). More specifically, heroin-associated deaths in Miami-Dade County rose 826% between 2011–2016(2). With Miami-Dade County atop the list in new HIV infections in the country, implementation of evidence-based HIV prevention coupled with overdose prevention was imperative.(3)
In 2016, Florida enacted the Infectious Disease Elimination Act, allowing a single pilot syringe services program (SSP) in Florida; the University of Miami IDEA SSP (IDEA). In the year following establishment of IDEA in Miami, approximately 518 PWID enrolled in services, and 795 kits of two 4 mg dose naloxone were distributed to participants. In addition to sterile needles and other injection supplies, participants in the IDEA-SSP are provided with education on safe injection practices. They are also instructed in the use of tester shots (sampling small amounts of a newly acquired drug before using the entire dose), using drugs with trusted friends, and spreading awareness of locations of previous overdose and bad batches—batches with unusually potent or otherwise toxic effects.(4)
In addition to exchanging syringes, SSPs provide comprehensive harm reduction services to people who inject drugs (PWID). These services include community distribution of take-home naloxone kits.(5) Take-home naloxone is an effective strategy for mitigating poor overdose outcomes as it reduces the time to administration versus activation of emergency medical services.(6) Community naloxone distribution removes barriers to naloxone access, a critical feature for populations that experience significant hesitation when seeking medical care, partially due to uninsured status, systemic bias and stigma associated with drug use. PWID are commonly the first responders at the scene of an overdose and reverse an overwhelming majority of overdoses in the community. A 2014 survey conducted by the Harm Reduction Coalition showed that from 1996–2014, 136 organizations across the United States distributed over 152,000 naloxone kits to laypersons in the community, and over 26,400 overdose reversals were reported.(7) Of the overdose reversals reported, 82.8% of individuals that used naloxone to save a life were PWID. Other research shows that PWID deploy take-home naloxone to save a life at a rate nearly ten times that of laypeople who do not use drugs – emphasizing the need to prioritize people who use drugs in naloxone distribution efforts.(8) However, PWID continue to face barriers to naloxone access, including cost and stigma.
Multiple systematic reviews have found take-home naloxone programs to be both safe and effective, leading to increased survival rates among participants and decreases in overdose mortality rates more broadly.(9–11) Although systemic analyses have found take-home naloxone programs are effective in reducing overdose deaths among program participants, there are few studies that assess the impact of take-home naloxone programs on hospitalizations. (10) One study of a community take-home naloxone distribution program that operates independent of an SSP found no reduction in emergency department visits or deaths(12). We present a study analyzing the early effects of the IDEA-SSP on incidence of admissions associated with opioid overdose at a county safety-net hospital in south Florida.