Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis

The authors note that 'OEND is an innovative, community based program deployed in many settings that has not been examined in controlled studies'. But how can the authors then go on to say: 'This study provides observational evidence that OEND is an effective public health intervention'? Perhaps they should have said 'This study provides observational evidence that OEND may be an effective public health intervention.' Especially when they have acknowledged that 'This study was observational and cannot demonstrate causality' and also that 'Opioid overdose related visits to emergency departments and hospital admission rates did not differ significantly in communities with low versus high OEND implementation.'

I am surprised that these contradictions got through the BMJ reviewing process. The plausibility of OEND is high but the actual evidence for OEND at present still only consists of a large number of observational studies. This is a low level of evidence. I would also like to believe that OEND is effective and safe. But drug users, their families and communities have paid an extremely high price for drug policies which seemed plausible but were supported only by large quantities of poor quality evidence. High quality evidence should be demanded for OEND just as it should for drug law enforcement.