Overdose Research in Rhode Island

Rhode Island is a leader in overdose research in the United States.

On this page, you will find published research studies involving overdose prevention and treatment in Rhode Island. For many of these studies, you will also find a link to the full article for free. These research studies help guide our state’s overdose response efforts.

You can also find a complete list of these research articles in PubMed, a free online library collection.

What is Rhode Island's response to the overdose crisis?

Emergency Department and Hospital Care for Opioid Use Disorder: Implementation of Statewide Standards in Rhode Island, 2017–2018

Elizabeth Samuels, James McDonald, Meghan McCormick, Jennifer Koziol, Catherine Friedman, Nicole Alexander-Scott
American Journal of Public Health, December 2018. doi: https://doi.org/10.2105/AJPH.2018.304847

In March 2017, Rhode Island released treatment standards for care of adult patients with opioid use disorder. This paper describes the standardized care policies for opioid use disorder, enhanced opioid overdose surveillance and response, and expanded linkage to peer recovery support, naloxone, and medication for opioid use disorder.

Action-focused, plain language communication for overdose prevention: A qualitative analysis of Rhode Island’s overdose surveillance and information dashboard

Katherine M. Waye, Jesse L.Yedinak, Jennifer Koziol, Brandon D.L.Marshall
International Journal of Drug Policy, October 2018. doi: 10.1016/j.drugpo.2018.08.010.

This paper discussed the website you’re on now, www.PreventOverdoseRI.org (PORI), and sought to determine how people who use drugs (PWUD) perceive and utilize overdose prevention material hosted on this website, and to evaluate PORI’s action-based, plain language content.

Rx for addiction and medication safety: An evaluation of teen education for opioid misuse prevention

Emily Patry, Jeffrey Bratberg, Ashley Buchanan, Andrea Paiva, Sara Balestrieri, Kelly Matson
Research in Social and Administrative Pharmacy, July 2018. doi: 10.1016/j.sapharm.2018.07.00

This paper measures how much 9th grade students learned about opioid overdose prevention, naloxone, and treatment and for an opioid use disorder from a substance use disorder curriculum. The authors found that the curriculum was effective at teaching the students about non-medical prescription opioid use, overdose response, and recovery resources.

Estimating the Direct Costs of Outpatient Opioid Prescriptions: A Retrospective Analysis of Data from the Rhode Island Prescription Drug Monitoring Program.

Hilary Aroke, Ashley Buchanan, Xuerong Wen, Peter Ragosta, Jennifer Koziol, Stephen Kogut
Journal of Managed Care and Specialty Pharmacy, March 2018. doi: 10.18553/jmcp.2018.24.3.214

This paper estimated the statewide direct cost burden of prescription opioid use using data from the Prescription Drug Monitoring Program (PDMP). The study suggests that cost savings could result from using generic forms of commonly prescribed opioid products. Reducing opioid use, especially among middle-aged people, could also save money and lead to better health outcomes.

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Rhode Island unintentional drug overdose death trends and ranking- office of the state medical examiners database

Yongwen Jiang, James McDonald, Maria Lena Wilson, Jennifer Koziol, Ariel Goldschmidt, Ewa King, Samara Viner-Brown, Sandra Powell, Nicole Alexander-Scott
Rhode Island Medical Journal, February 2018.

This paper described patterns of accidental overdoses in Rhode Island from 2009-2016. It also compared overdoses in Rhode Island to other states in New England. The study discussed how overdose numbers may increase if interventions to prevent overdose are not implemented.

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Using data to guide and evaluate responses to the opioid crisis: Rhode Island’s drug overdose dashboard

Brandon Marshall
National Network of Libraries of Medicine New England Region, March 2018. Repository 54.

This is the script from a webinar about the data dashboard, www.PreventOverdoseRI.org (PORI), the website you are on now. The webinar discussed the process for analyzing overdose surveillance data and metrics of the Governor’s Task Force Strategic Plan. Methods for improving data sharing and transparency were also discussed.

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Development of a statewide, publicly accessible drug overdose surveillance and information system

Brandon Marshall, Jesse Yedinak, Jonathan Goyer, Traci Green, Jennifer Koziol, Nicole Alexander-Scott
The American Journal of Public Health, November 2017. doi: 10.2105/AJPH.2017.304007.

This paper discussed the website you’re on now, www.PreventOverdoseRI.org (PORI), and its role in the response to Rhode Island’s overdose crisis. The website PORI was created as a data dashboard to increase sharing of overdose surveillance data,

Can Emergency department, hospital discharge, and death data be used to monitor burden of drug overdose in Rhode Island

Yongwen Jiang, James McDonald, Jennifer Koziol, Meghan McCormick, Samara Viner-Brown, Nicole Alexander-Scott
Journal of Public Health Management and Practice, September 2017. DOI: 10.1097/PHH.0000000000000514.

This paper used multiple overdose surveillance data sets to examine trends in overdose, including emergency department and medical examiner records. The study found that people who died from overdose were more likely to be young, male, white and live in suburban areas of Rhode Island.

Practical considerations for prescribing benzodiazepines and opioids

James McDonald, Victoria Ayers, Jackie Pacquin
Rhode Island Medical Journal, July 2017.

This paper discussed the serious risks of prescribing prescription opioids and benzodiazepines together. Strategic guidance was offered to minimize risks for patients: a) stop starting, b) taper, titrate and do not escalate, and c) monitor closely. This paper suggests these efforts will contribute to decreased risk of overdose among patients.

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Development and use of a new opioid overdose surveillance system, 2016

Meghan McCormick, Jennifer Koziol, Kelly Sanchez
Rhode Island Medical Journal, April 2017.

This paper described the surveillance system that was developed after Rhode Island passed emergency regulations to require all hospitals and emergency departments to report cases of opioid overdose within forty-eight hours. In October 2015, The Rhode Island Department of Health started an online Opioid Overdose Reporting System. The reporting system allowed the Department of Health to follow the overdose crisis in near real-time.

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The Rhode Island community responds to opioid overdose deaths

Sarah Bowman, Ariel Engelman, Jennifer Koziol, Linda Mahoney, Christopher Maxwell, Michelle McKenzie
Rhode Island Medical Journal, October 2014.

This article discussed the 2014 response to the overdose crisis in Rhode Island. It covers the multiple strategies and projects that came out of the early crisis, and how organizations came together to respond. Many of the approaches focused on increasing access to naloxone and improving treatment and recovery care for people with substance use disorders.

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Using the Rhode Island Prescription Monitoring Program (PMP)

James McDonald
Rhode Island Medical Journal, June 2014.

This paper offered an outline for prescribers to utilize the Prescription Drug Monitoring Program (PMP) as a means to combat the opioid crisis at the patient level. The paper outlines key guidelines for monitoring opioid prescribing, doses, and patient issues.

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Appropriate prescribing of opiates as professional conduct

James McDonald
Rhode Island Medical Journal, November 2013.

This paper covered 2013 standards for opioid prescribing from The Rhode Island Board of Medical Licensure and Discipline. These practices and standards were designed to increase responsible opioid prescribing among clinicians.

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How does fentanyl affect the overdose crisis in Rhode Island?

Methadone maintenance treatment among patients exposed to illicit fentanyl in Rhode Island: Safety, dose, retention, and relapse at 6 months

Andrew Stone, Jennifer Caroll, Josiah Rich, Traci Green
Drug and Alcohol Dependence, November 2018. doi:10.1016.j.drugalcdep.2018.07.019

This was the first study to look at methadone treatment for people who have been exposed to fentanyl. The researchers found that of the people who had been admitted for methadone treatment, 80% had tested positive for fentanyl. While most of the participants remained on methadone for 6 months, relapse was common, as was continued fentanyl exposure.

Use of rapid fentanyl test strips among young adults who use drugs

Maxwell Krieger, William Goedel, Jane Buxton, Mark Lysyshyn, Edward Bernstein, Susan Sherman, Josiah Rich, Scott Hadland, Traci Green, Brandon Marshall
International Journal of Drug Policy, October 2018. doi:10.1016/j.drugpo.2018.09.009

This study found that young adults who use drugs used fentanyl test strips to test their drugs. They found the test strips to be easy to use. Positive test strip results were more likely for people who use heroin, people who inject drugs, and ever witnessed an overdose. People were more likely to use a harm reduction strategy to help prevent overdose after having a positive test strip result.

Risk of fentanyl-involved overdose among those with past year incarceration: Findings from a recent outbreak in 2014 and 2015

Lauren Brinkley-Rubinstein, Alexandria Macmadu, Brandon Marshall, Andrew Heise, Shabbar Ranapurwala, Josiah Rich, Traci Green
Drug and Alcohol Dependence, April 2018. doi: 10.1016/j.drugalcdep.2017.12.014

This study found that Rhode Islanders who have been in jail in the previous year had an almost double the chance of a fentanyl overdose. This means that people who left jail may have benefitted from more help to prevent overdose when they were released, like getting medication-assisted treatment, overdose education, and naloxone in case of an overdose.

Increase in drug overdose deaths involving fentanyl—Rhode Island, January 2012–March 2014

Melissa Mercardo, Steven Sumner, M Bridget Spelke, Michele Bohm, David Sugarman, Christina Stanley
Pain Medicine, March 2018. doi: 10.1093/pm/pnx015.

This study described the characteristics of people who died from a drug overdose in Rhode Island from January 2012 to March 2014. People who died from fentanyl were more likely to be young and have used heroin recently. About 35%, that means 188 people of the 536 in the study, had an opioid prescription filled 90 days before their overdose death. The authors suggest that doctors and pharmacists should look up people’s substance use history on their medical records before prescribing opioids.

High willingness to use rapid fentanyl test strips among young adults who use drugs

Maxwell Krieger, Jesse Yedinak, Jane Buxton, Mark Lysyshyn, Ed Bernstein, Josiah Rich, Traci Green, Scott Hadland, Brandon Marshall
Harm Reduction Journal, February 2018. doi: 10.1186/s12954-018-0213-2.

This study tested willingness to use fentanyl drug test strips among young people who used drugs in Rhode Island. The strips helped detect fentanyl in drugs like heroin. The results suggested that nearly all people in the study thought the test strips would be easy to use to help prevent an overdose.

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Epidemiology of fentanyl-involved drug overdose deaths: A geospatial retrospective study in Rhode Island, USA

Brandon Marshall, Maxwell Krieger, Jesse Yedinak, Patricia Ogera, Priya Banerjee, Nicole Alexander-Scott, Josiah Rich, Traci Green
International Journal of Drug Policy, August 2017. doi: 10.1016/j.drugpo.2017.05.029.

This study assessed accidental drug overdose deaths across Rhode Island from January 2014 to September 2016. Almost half of the overdose deaths, that means 358 of the 788 total, were from fentanyl. The study reported that people who overdosed due to fentanyl tended to be younger, inject drugs, and used more than one drug at once. Overdoses from fentanyl were highest in cities like Providence and Woonsocket.

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Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically

Alexandria Macmadu, Jennifer Carroll, Scott Hadland, Traci Green, and Brandon Marshall
Journal of Addiction Behavior, May 2017. doi: 10.1016/j.addbeh.2017.01.014.

This study showed that fentanyl in heroin was a growing issue for young adults in Rhode Island from 2015 to 2016. Young adults who used cocaine and heroin, who had injected drugs, or who had overdosed before were most likely to think fentanyl was in their drugs.

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What role does naloxone play in community response to overdose?

The NaloxBox Program in Rhode Island: A Model for Community-Access Naloxone.

Geoffrey Capraro, Claudia Rebola
The American Journal of Public Health, December 2018. doi: 10.2105/AJPH.2018.304735.

This article describes the NaloxBox initiative, an innovative program to make naloxone more accessible, especially in communities with high overdose risk. NaloxBoxes are publicly-available units containing all the tools and instructions needed for a layperson to intervene in an overdose before emergency medical services arrive. To see where NaloxBoxes are available, visit our Naloxboxes page.

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An interprofessional education workshop to develop health professional student opioid misuse knowledge, attitudes, and skills

Kristina Monteiro, Luba Dumenco, Sally Collins, Jeffrey Bratberg, Celia MacDonnell, Anita Jacobson, Richard Dollase, Paul George
The Journal of the American Pharmacists Association, March 2017. doi: 10.1016/j.japh.2016.12.069.

This article describes the evaluation of educational workshops for health professional students at Brown University’s Warren Alpert Medical School. The workshops taught the students how to administer naloxone and how to treat people with substance use disorders. The workshops were found to be successful in increasing the student’s knowledge and showed that training health professional students may be useful in improving substance use care.

Factors associated with knowledge of a Good Samaritan Law among young adults who use prescription opioids non-medically

Tristan Evans, Scott Hadland, Melissa Clark, Traci Green, Brandon Marshall
Harm Reduction Journal, July 2016. doi:10.1186/s12954-016-0113-2.

This study found that less than half of young adults in Rhode Island who were surveyed knew about the Good Samaritan Law (Good Sam), a type of law that offers protection from arrest if a bystander calls 9-1-1 during an overdose. While less than half knew about Good Sam, almost all of the young adults said they would call 9-1-1 if someone was overdosing. This study suggests that expanded education about Good Sam would help young adults who use opioids non-medically respond to overdose.

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Orienting patients to greater opioid safety: models of community pharmacy-based naloxone

Traci Green, Emily Dauria, Jeffrey Bratberg, Corey Davis, Alexander Walley
Harm Reduction Journal, August 2015. doi:10.1186/s12954-015-0058-x.

This study examined Rhode Island’s pharmacy-based naloxone program, where the pharmacies in Rhode Island partnered with naloxone prescribers to expand naloxone distribution across the state. The results of this study suggested that offering naloxone in pharmacies may be an important part of a state-wide overdose response.

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How are Emergency Medical Services involved in preventing overdose?

Coordinating clinical and public health responses to opioid overdoses treated in emergency departments: Joint Webinar: Vital Signs Town Hall and COCA Call

Alana Kantor, Elizabeth Samuels, Meghan McCormick
Center for Disease Control and Prevention, March 2018.

This online lecture discussed data from opioid-related deaths at emergency departments. The lecture talked about ways public health workers and emergency departments can work together to prevent overdoses and increase treatment options. Additionally, important steps that emergency departments may take to prevent future overdoses were described.

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An initial evaluation of law enforcement overdose training in Rhode Island

Corey Saucier, Nickolas Zaller, Alexandria Macmadu, Traci Green
Drug and Alcohol Dependence, May 2016. doi: 10.1016/j.drugalcdep.2016.03.011.

This study evaluated a Rhode Island training for law enforcement officers in recognizing and responding to an overdose. The results showed that after having the overdose training, the officers were more prepared to recognize signs of an overdose, give naloxone, and knew about the Good Samaritan Law.

Use of Naloxone by emergency medical services during opioid drug overdose resuscitation efforts

Steven Allen Summer, Melissa Mercado-Crespo, M. Bridget Spelke, Leonard Paulozzi, David Sugerman, Susan Hills, Christina Stanley
Prehospital Emergency Care, March 2016. doi: 10.3109/10903127.2015.1076096.

This study wanted to determine how Emergency Medical Services (EMS) responders used naloxone when an overdose was thought to be happening. From 2014 to 2016, it was found that men were given naloxone nearly three times as often as women. Also, people younger than 30 were more likely to be given naloxone. The authors suggest that EMS does not always recognize that a person is having an overdose and that there should be more training about recognizing and responding to overdoses.

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What groups are affected by barriers to treatment?

Access to substance use treatment among young adults who use prescription opioids non-medically

Elliott Liebling, Jesse Yedinak, Traci Green, Scott Hadland, Melissa Clark, Brandon Marshall
Substance Abuse Treatment Prevention and Policy, November 2016.

This study examined how young adults in Rhode Island who use prescription opioids non-medically find and get into treatment for drug use. Study results suggested it was harder to get treatment for young adults who have overdosed before or who had been in jail.

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The More Things Change: Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible

Jennifer Carroll, Josiah D. Rich, Traci C. Green
Journal of Addiction Medicine, August 2018.

This study considered data from 2 Rhode Island based studies (conducted in 2009 and 2016, respectively) of people who use illicit or diverted prescription opioids and their patterns of buprenorphine/naloxone diversion. Using targeted sampling, individuals who use opioids completed a brief questionnaire about their drug use. The use of diverted/buprenorphine remains common among people who use opioids non-medically and indicates a severe shortage in treatment capacity and inaccessibility of existing services.

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What are Peer Recovery Coaches and how are they being used in overdose response?

Implementing peer recovery services for overdose prevention in Rhode Island: An examination of two outreach-based approaches

Katherine Waye, Jonathan Goyer, Debra Dettor, Linda Mahoney, Elizabeth Samuels, Jesse Yedinak, Brandon Marshall
Journal of Addictive Behaviors, February 2019. doi:10.1016/j.addbeh.2018.09.27

This paper describes how the emergency department-based peer recovery specialists, AnchorED and AnchoreMORE were created and implemented to prevent future overdoses for people who came to the emergency department because of an overdose. The authors found that these peer recovery services can help people who are at a high risk of experiencing an overdose get access to harm reduction services.

Peer navigation and take-home naloxone for opioid overdose emergency department patients: Preliminary patient outcomes

Elizabeth Samuels, Steven Bernstein, Brandon Marshall, Maxwell Krieger, Janette Baird, Michael Mello
Journal of Substance Abuse Treatment, November 2018. doi:10.1016/j.jsat.2018.07.013

This study evaluated a program that provided naloxone, peer recovery coaching, and treatment for people who came to the emergency department because of an overdose. The authors found that patients who had peer recovery coaching started treatment quicker than those who did not get peer recovery coaching. Also, they found that women and older patients were less likely to get naloxone or consultations for peer recovery coaching.

Emergency department Naloxone distribution: a Rhode Island department of health, recovery community, and emergency department partnership to reduce opioid overdose deaths

Elizabeth Samuels
Rhode Island Medical Journal, October 2014.

The Rhode Island Department of Health, Rhode Island emergency department (ED) doctors and the Anchor Community Recovery Center (Anchor) created a program to give out naloxone and offer peer-recovery coaching to people who come into an ED for an overdose. This paper describes the intervention that was created, where ED patients were given a take-home naloxone kit, trained on how to use the naloxone, and had the option to meet an Anchor peer recovery coach. This program started in August of 2014 at several Rhode Island EDs.

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Why are incarcerated people, young adults, and other groups most affected by the overdose crisis?

Rx for addiction and medication safety: An evaluation of teen education for opioid misuse prevention

Emily Patra, Jeffrey Bratberga, Ashley Buchanana, Andrea Paivab, Sara Balestrieri, Kelly Matsona
Research in Social and Administrative Pharmacy, July 2018. https://doi.org/10.1016/j.sapharm.2018.07.006

This study assessed changes in Rhode Island 9th grade students’ knowledge, confidence, perceptions of opioid use disorder prevention, overdose response with naloxone, treatment, and recovery, following the delivery of an interactive substance use disorder curriculum. Students report significant NMUPO prevalence.

Post-incarceration fatal overdoses after implementing medications for addiction treatment in a statewide correctional system

Traci Green, Jennifer Clarke, Lauren Brinkley-Rubinstein
JAMA Psychiatry, April 2018. doi:10.1001/jamapsychiatry.2017.4614.

This study assessed whether a program offering medication-assisted treatment (MAT) to people leaving the Rhode Island Department of Corrections would be useful in lowering overdose rates after release from prison. From 2016 to 2017, the number of overdoses from released inmates dropped by more than half. This study suggests that offering MAT upon release from jail or prison may be a useful strategy in lowering risk for overdose post-release.

A randomized, open label trial of methadone continuation versus forced withdrawal in a combined US prison and jail; Findings at 12 months post-release

Lauren Brinkley-Rubinstein, Michelle McKenzie, Alexandria Macmadu, Sarah Larney, Nickolas Zaller, Emily Dauria, Josiah Rich
Drug and Alcohol Dependence, March 2018. doi: 10.1016/j.drugalcdep.2017.11.023.

In this study, the authors found that people incarcerated at the Rhode Island Department of Corrections who were treated with methadone maintenance therapy were less likely to use heroin and injection drugs after being released. They were also less likely to have had an overdose and more likely to be in treatment in the year after being released.

Addressing excess risk of overdose among recently incarcerated people in the USA: Harm reduction interventions in correctional settings

Lauren Brinkley-Rubinstein, David Cloud, Nickolas Zaller, Ayesha Delaney-Brumsey, Leah Pope, Sarah Martino, Benjamin Bouvier, Josiah Rich
International Journal of Prison Health, March 2017. doi: 10.1108/IJPH-08-2016-0039.

This paper discussed programs to lower the chance of overdose among people who have been recently incarcerated. The authors suggested improvements to overdose and naloxone education, medication-assisted treatment (MAT) programs, and tools to assess risk for overdose.

Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomized, open-label trial

Josiah Rich, Michelle McKenzie, Sarah Larney, John Wong, Liem Tran, Jennifer CLarke, Amanda Noska, Manasa Reddy, Nickolas Zaller
The Lancet, July 2015. doi: 10.1016/S0140-6736(14)62338-2.

This study wanted to determine if methadone treatment in prison was helpful for continuing treatment outside of prison and possibly help lower the chance of overdose. The results found that people who were able to continue methadone treatment when they entered jail or prison doubled their chance of maintaining their treatment when released, as compared to those who were forced to stop their methadone treatment.

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Feasibility of prison-based overdose prevention education and prescribed naloxone at release

Traci Green, Sarah Bowman, Madeline Ray, Michelle McKenzie, Josiah Rich
Drug and Alcohol Dependence, July 2014. doi:10.1016/j.drugalcdep.2014.02.221.

This study assessed the effectiveness of an overdose recognition and response training video in a Rhode Island prison. The released inmates, one month later, had to show their new skills by acting out an overdose simulation. The study participants were successful in the one-month testing, suggesting that the prison setting may be a useful location for naloxone training.

Development of an incarceration-specific overdose prevention video: Staying Alive on the Outside

Traci Green, Sarah Bowman, Madeline Ray, Michelle McKenzie, Josiah Rich
Health Education Journal, September 2014.

This study was a systematic review of the content and theory behind overdose education videos. The results led to the creation of an educational video for prisoners in Rhode Island about overdose risk post-release, led by peer educators, entitled “Staying Alive on the Outside”. The intervention was tested for effectiveness at multiple locations.

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Injection drug use and overdose among young adults who use prescription opioids non-medically

Elliott Liebling, Traci Green, Scott Hadland, Brandon Marshall
Addictive Behaviors, January 2018. doi: 10.1016/j.addbeh.2017.07.017.

In this study, the authors found that 59 of the 199 young adults surveyed, who used prescription opioids not prescribed by their doctor, had injected drugs at some point in their lifetime. The authors discussed the importance of teaching overdose education and naloxone administration to people who injected prescription opioids.

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Social context and perspectives of non-medical prescription opioid use among young adults in Rhode Island: A qualitative study

Jesse Yedinak, Elizabeth Kinnard, Scott Hadland, Traci Green, Melissa Clark, Brandon Marshall
The American Journal of Addictions, December 2016. doi: 10.1111/ajad.12466.

The authors of this study interviewed young adults in Rhode Island who used prescription opioids non-medically. This study discussed drug use norms such as using multiple drugs in social settings, and risk factors for overdose among young adults.

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Harm reduction for young people who use prescription opioids extra-medically: Obstacles and opportunities

Brandon Marshall, Traci Green, Jesse Yedinak, Scott Hadland
International Journal of Drug Policy, May 2016. doi: 10.1016/j.drugpo.2016.01.02.

This paper reviewed harm reduction activities for young adults who use prescription opioids non-medically. Some of the programs discussed included needle and syringe programs, medication-assisted treatment, and supervised injecting facilities. The paper suggests the importance of including young adults in the creation of harm reduction programs in the United States.

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Are we missing anything?

To qualify for this page, we used the following criteria:

  • The studies were included in the online database PubMed or were published by a branch of the state government
  • The studies occurred in Rhode Island, or the study had a site located in Rhode Island
  • The studies were relevant to drug-related overdose
  • The studies were published anytime between 2014 and 2018

Please use the comment box at the bottom of the website to send us a message if you feel we have missed any research studies.