Attitudes of Emergency Medical Service Providers Towards Naloxone Distribution Programs (original) (raw)
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Journal of Urban Health-bulletin of The New York Academy of Medicine, 2003
Naloxone, an injectable opiate antagonist, can immediately reverse an opiate overdose and prevent overdose death. We sought to determine injection drug users’ (IDUs) attitudes about being prescribed take-home naloxone. During November 1999 to February 2000, we surveyed 82 street-recruited IDUs from the San Francisco Bay Area of California who had experienced one or more heroin overdose events. We used a questiomaire that included structured and open-ended questions. Most respondents (89%) had witnessed an overdose, and 90% reported initially attempting lay remedies in an effort to help companions survive. Only 51% reported soliciting emergency assistance (calling 911) for the last witnessed overdose, with most hesitating due to fear of police involvement. Of IDUs surveyed, 87% were strongly in favor of participating in an overdose management training program to receive take-home naloxone and training in resuscitation techniques. Nevertheless, respontdents expressed a variety of concerning attitudes. If provided naloxone, 35% predicted that they might feel comfortable using greater amounts of heroin, 62% might be less inclined to call 911 for an overdose, 30% might leave an overdose victim after naloxone resuscitation, and 46% might not be able to dissuade the victim from using heroin again to alleviate with drawal symptoms induced by naloxone. Prescribing take-home naloxone to IDUs with training in its use and in resuscitation techniques may represent a life-saving, peer-based adjunct to accessing emergency services. Nevertheless, strategies for overcoming potential risks associated with the use of take-home naloxone would need to be emphasized in an overdose management training program.
Journal of Public Health Management and Practice, 2017
Context: The United States is in the midst of an opioid overdose epidemic. Opioids killed more than 28 000 people in 2014, more than any year on record. One approach to addressing this growing epidemic is Opioid Overdose Education and Naloxone Distribution (OEND) training. Little is known about these programs' participants and their effectiveness across different demographic groups. Objectives: To examine (1) whether knowledge and attitudes improved over the course of the training programs; (2) whether training outcomes differ by demographics; and (3) what overdose experiences do attendees have, and whether those experiences influence their knowledge and attitudes. Design: A pre- and posttest survey was used to collect data on participants' demographics, overdose experiences, and opioid overdose knowledge and attitudes. Setting: Surveys that took place at community-wide OEND programs were offered throughout Erie County, New York, during October and November 2015. Participant...
Substance Abuse, 2018
Background-Overdose education and naloxone distribution (OEND) to people at risk of witnessing or experiencing an opioid overdose has traditionally been provided through harm reduction agencies. Expanding OEND to inpatient general medical settings may reach at-risk individuals who do not access harm reduction services and have not been trained. An OEND program targeting inpatients was developed, piloted, and evaluated on two general medicine floors at Montefiore Medical Center, a large urban academic medical center in the Bronx, NY. Methods-The planning committee consisted of ten resident physicians and two faculty mentors. A consult service model was piloted, whereby the primary inpatient care team paged the consult team (consisting of rotating members from the planning committee) for any newly admitted patient who had used any opioid in the year prior to admission. Consult team members assessed patients for eligibility and provided OEND to eligible patients through a short video training. Upon completion, patients received a take-home naloxone kit. To evaluate the program, a retrospective chart review over the first year (April 2016-March 2017) of the pilot was conducted.
Journal of Urban Health: Bulletin of the New York Academy of Medicine, 2003
Preliminary research suggests that naloxone (Narcan), a short-acting opiate antagonist, could be provided by prescription or distribution to heroin users to reduce the likelihood of fatality from overdose. We conducted a random postal survey of 1,100 prescription-authorized health care providers in New York City to determine willingness to prescribe naloxone to patients at risk of an opiate overdose. Among 363 nurse practitioners, physicians, and physician assistants responding, 33.4% would consider prescribing naloxone, and 29.4% were unsure. This preliminary study suggests that a substantial number of New York City health care providers would prescribe naloxone for opiate overdose prevention.
Background: In an effort to prevent opioid overdose mortality among Veterans, Department of Veterans Affairs (VA) facilities began implementing opioid overdose education and naloxone distribution (OEND) in 2013 and a national program began in 2014. VA is the first national health care system to implement 15 OEND. The goal of this study is to examine patient perceptions of OEND training and naloxone kits. Methods: Four focus groups were conducted between December 2014 and February 2015 with 21 patients trained in OEND. Participants were recruited from a VA residential facility in California with a substance use disorder treatment program (mandatory OEND training) and a homeless program (optional OEND training). Data were analyzed using matrices and open and closed coding approaches to identify what 20 participants liked and did not like, group discussion disagreements, and suggestions for improvement. Results: Veterans thought OEND training was interesting, novel, and empowering, and that naloxone kits will save lives. Some veterans expressed concern about using syringes in the kits. A few patients who never used opioids were not interested in receiving kits. Veterans had differing opinions about legal and liability issues, whether naloxone kits might contribute to relapse, and whether and how to involve family 25 in training. Some veterans expressed uncertainty about the effects of naloxone. Suggested improvements included active learning approaches, enhanced training materials, and increased advertisement. Conclusions: OEND training was generally well received among study participants, including those with no indication for a naloxone kit. Patients described a need for OEND and believed it could save lives. Patient feedback on OEND training benefits, concerns, opinions, and suggestions provides important insights to 30 inform future OEND training programs both within VA and in other health care settings. Training is critical to maximizing the potential for OEND to save lives, and this study includes specific suggestions for improving the effectiveness and acceptability of training.
Evaluation of a Naloxone Distribution and Administration Program in New York City
Substance Use & Misuse, 2008
Naloxone, an opiate antagonist that can avert opiate overdose mortality, has only recently been prescribed to drug users in a few jurisdictions (Chicago, Baltimore, New Mexico, New York City, and San Francisco) in the United States. This report summarizes the first systematic evaluation of large-scale naloxone distribution among injection drug users (IDUs) in the United States. In 2005, we conducted an evaluation of a comprehensive overdose prevention and naloxone administration training program in New York City. One hundred twenty-two IDUs at syringe exchange programs (SEPs) were trained in Skills and Knowledge on Overdose Prevention (SKOOP), and all were given a prescription for naloxone by a physician. Participants in SKOOP were over the age of 18, current participants of SEPs, and current or former drug users. Participants completed a questionnaire that assessed overdose experience and naloxone use. Naloxone was administered 82 times; 68 (83.0%) persons who had naloxone administered to them lived, and the outcome of 14 (17.1%) overdoses was unknown. Ninety-seven of 118 participants (82.2%) said they felt comfortable to very comfortable using naloxone if indicated; 94 of 109 (86.2%) said they would want naloxone administered if overdosing. Naloxone administration by IDUs is feasible as part of a comprehensive overdose prevention strategy and may be a practicable way to reduce overdose deaths on a larger scale.
The Emergency Department as an Opportunity for Naloxone Distribution
Western Journal of Emergency Medicine
Substance use disorders, including opioid use disorders, are a major public health concern in the United States. Between 2005 and 2014, the rate of opioid-related emergency department (ED) visits nearly doubled, from 89.1 per 100,000 persons in 2005 to 177.7 per 100,000 persons in 2014. Thus, the ED presents a distinctive opportunity for harm-reduction strategies such as distribution of naloxone to patients who are at risk for an opioid overdose. Methods: We conducted a systematic review of all existing literature related to naloxone distribution from the ED. We included only those articles published in peer-reviewed journals that described results relating to naloxone distribution from the ED. Results: Of the 2,286 articles we identified from the search, five met the inclusion criteria and had direct relevance to naloxone distribution from the ED setting. Across the studies, we found variation in the methods of implementation and evaluation of take-home naloxone programs in the ED. In the three studies that attempted patient follow-up, success was low, limiting the evidence for the programs' effectiveness. Overall, in the included studies there is evidence that distributing take-home naloxone from the ED has the potential for harm reduction; however, the uptake of the practice remained low. Barriers to implementation included time allocated for training hospital staff and the burden on workflow. Conclusion: This systematic review of the best evidence available supports the ED as a potential setting for naloxone distribution for overdose reversal in the community. The variability of the implementation methods across the studies highlights the need for future research to determine the most effective practices. [
Substance Abuse Treatment, Prevention, and Policy, 2020
The study background In 2015 a county sheriff department in Michigan began a training program for its deputies on administration of naloxone for non-medical providers. Methods A descriptive analysis was used to evaluate the effectiveness of the program. Data collected from the Sheriff’s department allowed the study to quantify the incidence of naloxone administration, describe characteristics related to the administration, and report on aggregate outcomes. Results Of the reported 184 incidents involving naloxone use the sheriff department had an overall successful administration rate of 94.6% in the cases from 2015 to 2017. It was also noted that the overall number of naloxone administrations showed an upward trend with a greater number of trained deputies. Conclusion The outcome of training non-medical first responders in naloxone administration has been shown to be successful with regard to resuscitation of patients with opioid overdose.
Assessing pharmacists’ readiness to dispense naloxone and counsel on responding to opioid overdoses
Journal of the American Pharmacists Association, 2019
Objectives: The United States declared the opioid crisis a Public Health Emergency in 2017 and recommended increasing access and availability of naloxone, a reversal agent for opioid overdose. In Massachusetts, there is a statewide standing order for naloxone, which allows pharmacists to dispense it without a prescription to any person at-risk of experiencing an opioid overdose or other persons who can assist individuals at-risk. The objective of this study was to determine whether pharmacists in Massachusetts have sufficient education and training to fulfill the duties associated with dispensing naloxone in community pharmacy settings. The researchers investigated the pharmacists' ability to counsel patients both on naloxone and management of patients with an opioid overdose. Methods: At the time of the study, pharmacies could elect to have a standing order for naloxone. A randomized sample of 100 pharmacies was generated from the 792 pharmacies with a standing order. From this sample, 79 of the 100 pharmacies were visited on the basis of convenience and distribution in eastern and central Massachusetts. At each pharmacy, a validated 25-item survey was administered to pharmacists. Results: Fewer than half of participants knew that different formulations of naloxone possess different quantities. Although 52% of pharmacists indicated the need to call 9-1-1 when witnessing an opioid overdose, 8% knew to start rescue breathing, and 4% knew to place patients in the recovery position. Conclusion: Despite regulations requiring all pharmacies with a standing order to provide training on naloxone, many of the pharmacists surveyed did not have a strong understanding about naloxone products or its pharmacology. The level of education Massachusetts pharmacists possess on naloxone products and administration is not sufficient to counsel patients regarding this medication. Increasing training requirements in pharmacy schools and continuing education offers potential solutions to the lack of knowledge in the community pharmacy setting.