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Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths.
Samet, Jeffrey H; El-Bassel, Nabila; Winhusen, T John; Jackson, Rebecca D; Oga, Emmanuel A; Chandler, Redonna K; Villani, Jennifer; Freisthler, Bridget; Adams, Joella; Aldridge, Arnie; Angerame, Angelo; Babineau, Denise C; Bagley, Sarah M; Baker, Trevor J; Balvanz, Peter; Barbosa, Carolina; Barocas, Joshua; Battaglia, Tracy A; Beard, Dacia D; Beers, Donna; Blevins, Derek; Bove, Nicholas; Bridden, Carly; Brown, Jennifer L; Bush, Heather M; Bush, Joshua L; Caldwell, Ryan; Calver, Katherine; Calvert, Deirdre; Campbell, Aimee N C; Carpenter, Jane; Caspar, Rachel; Chassler, Deborah; Chaya, Joan; Cheng, Debbie M; Cunningham, Chinazo O; Dasgupta, Anindita; David, James L; Davis, Alissa; Dean, Tammy; Drainoni, Mari-Lynn; Eggleston, Barry; Fanucchi, Laura C; Feaster, Daniel J; Fernandez, Soledad; Figueroa, Wilson; Freedman, Darcy A; Freeman, Patricia R; Freiermuth, Caroline E; Friedlander, Eric.
Afiliación
  • Samet JH; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • El-Bassel N; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Winhusen TJ; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Jackson RD; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Oga EA; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Chandler RK; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Villani J; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Freisthler B; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Adams J; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Aldridge A; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Angerame A; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Babineau DC; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Bagley SM; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Baker TJ; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Balvanz P; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Barbosa C; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Barocas J; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Battaglia TA; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Beard DD; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Beers D; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Blevins D; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Bove N; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Bridden C; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Brown JL; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Bush HM; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Bush JL; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Caldwell R; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Calver K; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Calvert D; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Campbell ANC; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Carpenter J; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Caspar R; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Chassler D; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Chaya J; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Cheng DM; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Cunningham CO; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Dasgupta A; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • David JL; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Davis A; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Dean T; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Drainoni ML; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Eggleston B; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Fanucchi LC; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Feaster DJ; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Fernandez S; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Figueroa W; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Freedman DA; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Freeman PR; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Freiermuth CE; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
  • Friedlander E; The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian a
N Engl J Med ; 391(11): 989-1001, 2024 Sep 19.
Article en En | MEDLINE | ID: mdl-38884347
ABSTRACT

BACKGROUND:

Evidence-based practices for reducing opioid-related overdose deaths include overdose education and naloxone distribution, the use of medications for the treatment of opioid use disorder, and prescription opioid safety. Data are needed on the effectiveness of a community-engaged intervention to reduce opioid-related overdose deaths through enhanced uptake of these practices.

METHODS:

In this community-level, cluster-randomized trial, we randomly assigned 67 communities in Kentucky, Massachusetts, New York, and Ohio to receive the intervention (34 communities) or a wait-list control (33 communities), stratified according to state. The trial was conducted within the context of both the coronavirus disease 2019 (Covid-19) pandemic and a national surge in the number of fentanyl-related overdose deaths. The trial groups were balanced within states according to urban or rural classification, previous overdose rate, and community population. The primary outcome was the number of opioid-related overdose deaths among community adults.

RESULTS:

During the comparison period from July 2021 through June 2022, the population-averaged rates of opioid-related overdose deaths were similar in the intervention group and the control group (47.2 deaths per 100,000 population vs. 51.7 per 100,000 population), for an adjusted rate ratio of 0.91 (95% confidence interval, 0.76 to 1.09; P = 0.30). The effect of the intervention on the rate of opioid-related overdose deaths did not differ appreciably according to state, urban or rural category, age, sex, or race or ethnic group. Intervention communities implemented 615 evidence-based practice strategies from the 806 strategies selected by communities (254 involving overdose education and naloxone distribution, 256 involving the use of medications for opioid use disorder, and 105 involving prescription opioid safety). Of these evidence-based practice strategies, only 235 (38%) had been initiated by the start of the comparison year.

CONCLUSIONS:

In this 12-month multimodal intervention trial involving community coalitions in the deployment of evidence-based practices to reduce opioid overdose deaths, death rates were similar in the intervention group and the control group in the context of the Covid-19 pandemic and the fentanyl-related overdose epidemic. (Funded by the National Institutes of Health; HCS ClinicalTrials.gov number, NCT04111939.).
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sobredosis de Opiáceos / Naloxona Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: N Engl J Med Año: 2024 Tipo del documento: Article
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sobredosis de Opiáceos / Naloxona Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: N Engl J Med Año: 2024 Tipo del documento: Article