Barriers to implementation of opioid overdose prevention programs in Ohio

ABSTRACT

Background: Nationally, overdose fatalities have reached epidemic proportions. Ohio has one of the highest overdose death rates in the country, as well as high rates of prescription opioid trafficking. Methods: A cross-sectional self-report survey of opioid overdose prevention programs (OOPPs) in Ohio was conducted between August and October 2014 to characterize programs and ascertain barriers to successful implementation. A 91% response rate was achieved with 18 programs participating in the study. Results: The first Ohio OOPP opened in August 2012, a second program opened in 2013, and the remaining programs began in 2014. All of the programs distribute nasal naloxone and provide overdose prevention education, and 89% (n = 16) provide overdose kits for free. Six OOPPs are funded by the Ohio Department of Health, 3 programs are funded by a local health foundation, and several other public and private funding sources were reported. The OOPPs have funding to distribute a combined total of 8,670 overdose kits and had distributed 1998 kits by October 2014. The OOPPs reported 149 overdose reversals. Fifteen programs (83%) reported implementation barriers that were categorized as stigma-, cost-, staffing-, legal, regulatory, and client-related problems. Legislative changes aimed at removing some of the obstacles to distribution and lay administration of naloxone have recently been enacted in Ohio. Conclusions: OOPPs have rapidly expanded in Ohio during the past 3 years. Although recent legislative changes have addressed some of the reported implementation barriers, stigma and the cost of naloxone remain significant problems.

KEYWORDS:

• Naloxone
• opioid overdose
• prevention

Acknowledgments

We want to thank Interact for Health and the Ohio Department of Health for their assistance in locating overdose prevention programs in the state, as well as the OOPPs for participating in the survey. Additionally, we would like to thank Amanda Stover and Rebecca Mashni for their data assistance. The authors do not have any conflicts of interest to report.

Author contributions

E.W. designed the study and developed the survey instrument, and made the initial contact with overdose program representatives. A.C. followed up with participants and conducted some of the telephone interviews. E.W. and A.C. drafted the manuscript. All authors provided critical revisions to the manuscript and reviewed the final version.