# Effectiveness of a Rescue Medication in Preventing Opioid Overdose in Veterans

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2021 · —

## Abstract

Background: In Spring 2014 the VA launched a national Opioid Overdose Education and Naloxone
Distribution (OEND) program with the support of the VA Under Secretary for Health1. In launching VA's OEND
initiative, the Under Secretary for Health acknowledged that most of the evidence to date surrounds OEND
targeting community-dwelling persons with documented opioid use disorders or opioid misuse rather than all
patients receiving opioid analgesics in a health care system. The VA OEND program was the first to target two
distinct patient populations: (1) patients with opioid use disorders and (2) patients prescribed opioid analgesics.
As of May 22, 2016 VA facilities have dispensed just over 27,000 naloxone kits to Veterans with every VA
facility participating in naloxone distribution (VA Naloxone Kit Distribution Report). As the first large health care
system in the United States to implement OEND, there is a great deal that can be learned from VA in terms of
whether current recommendations for OEND implementation are sound and/or whether they should be tailored
to specific subsets of patients. To address concerns about the effectiveness of OEND in health care settings,
an evaluation of OEND is necessary to examine whether it reduces opioid overdose as intended for at-risk
patients prescribed opioid analgesics and patients with opioid use disorders.
Objectives: The proposed study will pursue the following objectives:
Objective 1: Characterize naloxone distribution within VA and patient-, prescriber-, and setting-related
factors associated with distribution.
Objective 2: Assess whether naloxone distribution to at-risk Veterans compared to similar at-risk
Veterans who did not receive naloxone is associated with reduced fatal and non-fatal opioid overdose.
Theoretical Framework: The Reach, Effectiveness, Adoption, Implementation, and Maintenance—RE-AIM—
framework will guide our study. This framework considers both individual- (e.g., patient) and institutional-level
(e.g., setting) factors when evaluating the impact of interventions.
Methods: We will identify a cohort of patients from Fiscal Year 2014 Quarter 3 (FY2014 Q3; the start of the
national OEND program) through FY2017 Q1 (end of calendar year 2016) comprising at-risk patient
populations: (1) patients with opioid use disorders and (2) at-risk patients prescribed opioid analgesics.
Objective 1: For the identified cohort, we will obtain data from the VA Corporate Data Warehouse (CDW) and
provide descriptive statistics on the characteristics of patients who receive naloxone, prescribers who prescribe
naloxone, and settings in which naloxone is prescribed. We will also use mixed-effects logistic regression
models to identify patient-, prescriber-, and setting-level differences between patients who do and do not
receive naloxone.
Objective 2: Our primary analysis will use marginal structural models (MSMs) to examine the effect of naloxone
distribution for two main sets of outcomes: (1) Fatal opioid ov...

## Key facts

- **NIH application ID:** 9757711
- **Project number:** 5I01HX002193-03
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** Elizabeth M. Oliva
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-01-01 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9757711

## Citation

> US National Institutes of Health, RePORTER application 9757711, Effectiveness of a Rescue Medication in Preventing Opioid Overdose in Veterans (5I01HX002193-03). Retrieved via AI Analytics 2026-06-09 from https://api.ai-analytics.org/grant/nih/9757711. Licensed CC0.

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