Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island

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Abstract
The United States recorded nearly 71 000 drug overdose deaths in 2019.1 This number increased by approximately 30% in 2020 and another 15% in 2021, such that at this time, the Centers for Disease Control and Prevention (CDC) estimate more than 100 000 overdose deaths occur annually.2 In Rhode Island, drug overdose deaths increased by nearly 25% in 2020 compared with 2019 and 14% in 2021 compared with 2020, in contrast with a decrease in overdose deaths from 2016 to 2019.3 The increase in drug overdose deaths during the COVID-19 era can be attributed to social and physical isolation, decreased access to substance use treatment and harm reduction services, and the increasing presence of fentanyl, a rapidly acting synthetic opioid with a narrow response window, in the illicit drug supply, which accounted for 76% of drug overdose deaths in Rhode Island during the COVID-19 era.4

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