Background: Maryland expanded its "Statewide
Naloxone Standing Order" (NSO) in 2017 to eliminate training and prescription requirements for obtaining
naloxone, improve
naloxone access, help reverse
opioid overdose, and reduce overdose fatality rates.Objectives: To assess the change in the trends of fatal
opioid overdose rates following the expansion of the
Naloxone Standing Order (eNSO) and its association with the social determinants of health (SDoH).Methods: Data on overdose deaths and SDoH from 2015-2019 was collected and analyzed using interrupted time series and multivariate Poisson regression models to study the change in trends and the associations.Results: There was a significant decrease in the rate of fatal overdoses after the intervention: prescription
opioid estimate number of deaths declined by .25 per 100,000 (p = .02),
heroin estimate number of deaths declined by 1.83 per 100,000 (p < .001),
fentanyl estimate number of deaths declined by 2.54 per 100,000 (p < .001). After controlling for eNOS implementation in Maryland, state-level estimates with high proportions of female residents and those with bachelor's degree or higher were associated with reduction in overdose, while state-level estimates with high proportions of African Americans and higher employment rates were associated with an increase in overdose.Conclusions: Our analysis shows that the expanded
naloxone standing order is associated with reducing
opioid-related overdose death rates. Even though we observed a significant reduction in overdose death rate in
fentanyl-related deaths, the rate of deaths post-eNSO was still increasing, suggesting the need for additional measures to impact the rates of
fentanyl.