Family carers and the prevention of heroin overdose deaths: Unmet training need and overlooked intervention opportunity of resuscitation training and supply of naloxone

Strang, John; Manning, Victoria; Mayet, Soraya; Titherington, Emily; Offor, Liz; Semmler, Claudia; Williams, Anna

doi:10.1080/09687630701731205

Cited by 42 publications

(43 citation statements)

References 27 publications

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“…Both the staff training and bystander training were adapted from existing program curricula from other cities that primarily used needlebased naloxone. 8,14,[17][18][19][20][21] The 15-minute bystander training included techniques in overdose prevention. Staff completed a checklist (available as a supplement to the online article at http://www.ajph.org) to ensure participant comprehension.…”

Section: Program Curriculummentioning

confidence: 99%

Saved by the Nose: Bystander-Administered Intranasal Naloxone Hydrochloride for Opioid Overdose

Doe-Simkins

Walley²,

Epstein³

et al. 2009

Am J Public Health

213

183

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Administering naloxone hydrochloride (naloxone) during an opioid overdose reverses the overdose and can prevent death. Although typically delivered via intramuscular or intravenous injection, naloxone may be delivered via intranasal spray device. In August 2006, the Boston Public Health Commission passed a public health regulation that authorized an opioid overdose prevention program that included intranasal naloxone education and distribution of the spray to potential bystanders. Participants were taught by trained nonmedical needle exchange staff. After 15 months, the program provided training and intranasal naloxone to 385 participants who reported 74 successful overdose reversals. Problems with intranasal naloxone were uncommon. Overdose prevention education with distribution of intranasal naloxone is a feasible public health intervention to address opioid overdose.

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Section: Program Curriculummentioning

confidence: 99%

Saved by the Nose: Bystander-Administered Intranasal Naloxone Hydrochloride for Opioid Overdose

Doe-Simkins

Walley²,

Epstein³

et al. 2009

Am J Public Health

213

183

View full text Add to dashboard Cite

show abstract

“…We then extended our thinking to another strangely overlooked potential intervention work-force: the family [38]. With the benefit of hindsight, it is surprising how long it took us to realize the intervention opportunity and the strategic importance of engaging the family (at the time of writing, they are still rarely considered in plans for wider provision of take-home naloxone).…”

Section: Before Trainingmentioning

confidence: 99%

Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths

Strang

2015

Addiction

Self Cite

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Aims To describe work undertaken over a 20-year period, investigating overdose characteristics among survivors, effects of acute heroin administration, clustering of risk of overdose fatality and potential interventions to reduce this fatal outcome. Methods Privileged-access interviewers obtained data from non-treatment as well as treatment samples; experimental study of drop in oxygen saturation following heroin/opiate injection; investigation of clusterings of death following prison release and treatment termination; and study of target populations as intervention work-force, including family as well as peers, and action research built into pilot implementation. Results Overdose has been experienced by about half of heroin/opiate misusers, with even higher proportions having witnessed an overdose, and with high levels of willingness to intervene. Heroin/opiates are associated with the majority of drug-related deaths, despite relative scarcity of use. Heroin injection causes a rapid drop in oxygen saturation, recovering only slowly over the next half hour. Deaths from drug overdose are greatly more likely on prison release and post-discharge from detoxification and other in-patient or residential settings. High levels of declared willingness to intervene are matched by active interventions. Both drug-using peers and family members show ability to improve knowledge and gain confidence from training. Audit study of take-home schemes finds approximately 10% of dispensed naloxone is used in real-life emergency situations.Conclusions Overdose is experienced by most users, with heroin/opiates contributing disproportionately to drug overdose deaths. High-risk times (e.g. after prison release) are now clearly identified. Peers and family are a willing potential intervention work-force, but are rarely trained or given pre-supply of naloxone. Large-scale naloxone provision (e.g. national across Scotland and Wales) is now being delivered, while large-scale randomized trials (e.g. N-ALIVE prison-release trial) are finally under way. Better naloxone products and better-organized provision are needed. The area does not need more debate; it now needs proper implementation alongside good scientific study.

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“…In an England-based postal survey (Strang et al, 2008b), the majority of family members expressed strong interest in THN training.…”

Section: Training Opioid Users and Their Family Membersmentioning

confidence: 99%

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

McDonald

Campbell

Strang

2017

Drug and Alcohol Dependence

Self Cite

110

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Highlights Deaths from opioid overdose can be prevented by prompt administration of naloxone  It has been 20 years since take-home naloxone provision was first proposed  Take-home naloxone programs have recently overcome legal barriers in many countries  Take-home naloxone provision remains low compared to evident growing clinical need  The 'opt-out' model of required pre-provision may achieve wider naloxone coverage Abstract Background: Opioid overdose is a major cause of mortality, but injury and fatal outcomes can be prevented by timely administration of the opioid antagonist naloxone. Pre-provision of naloxone to opioid users and family members (take-home naloxone, THN) was first proposed in 1996, and WHO Guidelines were issued in 2014. While widespread in some countries, THN is minimally available or absent elsewhere. This review traces the development of THN over twenty years, from speculative harm reduction proposal to public health strategy.Method: Medline and PsycINFO were searched for peer-reviewed literature using Boolean queries: 1) "naloxone OR Narcan"; 2) "(opioid OR opiate) AND overdose AND prevention". Grey literature and specialist websites were also searched. Data were extracted and synthesized as narrative review, with key events presented as chronological timeline. Results Conclusions:Framed as a public health tool for harm reduction, THN has overcome social, clinical, and legal barriers in many jurisdictions. Nonetheless, the rising death toll of opioid overdose illustrates that current THN coverage is insufficient, and greater public investment in overdose prevention will be required if THN is to achieve its full potential impact.

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Family carers and the prevention of heroin overdose deaths: Unmet training need and overlooked intervention opportunity of resuscitation training and supply of naloxone

Cited by 42 publications

References 27 publications

Saved by the Nose: Bystander-Administered Intranasal Naloxone Hydrochloride for Opioid Overdose

Saved by the Nose: Bystander-Administered Intranasal Naloxone Hydrochloride for Opioid Overdose

Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

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