# Preventing Opioid Overdose Mortality in the United States

> **NIH NIH R01** · RESEARCH TRIANGLE INSTITUTE · 2020 · $425,444

## Abstract

We propose an R01 study by a new, early stage investigator that seeks to understand and improve
naloxone implementation within syringe service programs (SSPs) to reduce opioid overdose mortality in the
United States. The age-adjusted opioid overdose mortality rate rose nearly 200% from 2000 to 2014 and
increased another 16% from 2014 to 2015. These data indicate that the opioid overdose epidemic continues to
surge in the United States. Naloxone is an evidence-based biomedical intervention that reverses opioid
overdose, effectively preventing opioid overdose mortality. The study team has developed an implementation
manual for naloxone implementation in various settings including SSPs. Yet, only 15% of U.S. counties with
the highest overdose mortality levels have a community-based, naloxone program operating within them.
Furthermore, only 56% of SSPs, one of the best venues through which to implement this intervention, have
implemented naloxone. A nuanced understanding of where naloxone delivery within SSPs falls along the four
phases of the implementation process—from Exploration and Preparation to Implementation and Sustainment
(EPIS)—is critical to focus intervention efforts. A recent systematic review concluded that dissemination alone
is necessary but often insufficient to advance the desired adoption of interventions. There is, therefore, an
urgent need to empirically identify implementation strategies that can significantly improve upon dissemination
approaches. One such strategy—external facilitation—has demonstrated effectiveness in medical settings, but
no research has experimentally tested its use to improve delivery of a biomedical intervention in community-
based organizations such as SSPs. We propose an external facilitation intervention, shown to improve
implementation in HIV service settings, to identify barriers to and needs for and facilitate start-up of naloxone
delivery within SSPs. Aim 1 is to characterize U.S. SSPs along the exploration, preparation, implementation,
and sustainment continuum for delivering the naloxone intervention. Aim 2 is to test the effectiveness of
external facilitation to improve the advancement of the naloxone intervention along the EPIS continuum among
U.S. SSPs compared with dissemination of the implementation manual alone. To achieve Aim 1, we will
conduct a cross-sectional study with all SSPs (N=275) throughout the United States. To achieve Aim 2, we will
conduct a randomized controlled trial with the following arms: (1) dissemination of an implementation manual
and external facilitation for 12 months (experimental arm) and (2) dissemination of an implementation manual
only (control arm). All SSPs not yet implementing naloxone and interested in participating (estimated N = 100)
will be randomly assigned in a 1:1 ratio to the study arms. Advancement of naloxone along the EPIS
continuum will be assessed via surveys 12 months post randomization. Together, these efforts can improve
access to naloxone fo...

## Key facts

- **NIH application ID:** 9922273
- **Project number:** 5R01DA046867-03
- **Recipient organization:** RESEARCH TRIANGLE INSTITUTE
- **Principal Investigator:** Barrot Hopkins Lambdin
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $425,444
- **Award type:** 5
- **Project period:** 2018-07-15 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9922273

## Citation

> US National Institutes of Health, RePORTER application 9922273, Preventing Opioid Overdose Mortality in the United States (5R01DA046867-03). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/9922273. Licensed CC0.

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