Impacts of an opioid overdose prevention intervention delivered subsequent to acute care

Banta‐Green, Caleb J.; Coffin, Phillip O.; Merrill, Joseph O.; Sears, Jeanne M.; Dunn, Chris; Floyd, Anthony S.; Whiteside, Lauren K.; Yanez, N. David; Donovan, Dennis M.

doi:10.1136/injuryprev-2017-042676

Cited by 40 publications

(57 citation statements)

References 34 publications

(18 reference statements)

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“…Trainings by first responders or in ED could be particularly effective given that a history of overdose is a strong predictor of subsequent overdose, though research suggests that witnessing an overdose is a stronger predictor of naloxone uptake than personal experience of overdose [23,[29][30][31]. Prior research has also demonstrated that patients generally accept take-home naloxone kits when offered in the ED [29], however there is some evidence to show that overdose prevention interventions among those at risk in the ED may not have an impact on subsequent overdose [32]. Efforts to promote initiation of opioid agonist treatment in the ED may be an efficient and effective strategy to reduce overdose mortality [33].…”

Section: Discussionmentioning

confidence: 99%

Fatal overdose prevention and experience with naloxone: A cross-sectional study from a community-based cohort of people who inject drugs in Baltimore, Maryland

et al. 2020

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Introduction Overdose is a leading cause of death in the United States, especially among people who inject drugs (PWID). Improving naloxone access and carrying among PWID may offset recent increases in overdose mortality associated with the influx of synthetic opioids in the drug market. This study characterized prevalence and correlates of several naloxone outcomes among PWID. Methods During 2018, a survey to assess experience with naloxone was administered to 915 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study, an ongoing community-based observational cohort of people who currently inject or formerly injected drugs in Baltimore, Maryland. We examined the associations of naloxone outcomes (training, supply, use, and regular possession) with socio-demographic, substance use and healthcare utilization factors among PWID in order to characterize gaps in naloxone implementation among this high-risk population. Results Median age was 56 years, 34% were female, 85% were African American, and 31% recently injected. In the past six months, 46% (n = 421) reported receiving training in overdose prevention, 38% (n = 346) had received a supply of naloxone, 9% (n = 85) had administered naloxone, and 9% (n = 82) reported usually carrying a supply of naloxone. Recent non-fatal overdose was not associated with any naloxone outcomes in adjusted analysis. Active opioid use (aOR = 2.10, 95% CI: 1.03, 4.28) and recent treatment of alcohol or substance use disorder (aOR = 2.01, 95% CI: 1.13, 3.56) were associated with regularly carrying naloxone.

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Section: Discussionmentioning

confidence: 99%

Fatal overdose prevention and experience with naloxone: A cross-sectional study from a community-based cohort of people who inject drugs in Baltimore, Maryland

et al. 2020

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“…For harm reduction interventions to be efficacious, further studies with participant feedback and human factor testing are needed to ensure that the system meets the needs, values, and preferences of people who use opioids, in addition to establishing the system's safety vis-à-vis its potential to encourage moral hazard. Other harm reduction interventions such as take-home naloxone programs have been found not to increase risky behavior or lead to adverse health consequences (42)(43)(44). Previous data on harm reduction interventions show that people are willing to engage in behaviors to help keep themselves safe, such as using needle exchanges, take-home naloxone, face shields for mouth-tomouth respiratory support, and SIFs (45)(46)(47).…”

Section: Discussionmentioning

confidence: 99%

Opioid overdose detection using smartphones

2019

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Early detection and rapid intervention can prevent death from opioid overdose. At high doses, opioids (particularly fentanyl) can cause rapid cessation of breathing (apnea), hypoxemic/hypercarbic respiratory failure, and death, the physiologic sequence by which people commonly succumb from unintentional opioid overdose. We present algorithms that run on smartphones and unobtrusively detect opioid overdose events and their precursors. Our proof-of- concept contactless system converts the phone into a short-range active sonar using frequency shifts to identify respiratory depression, apnea, and gross motor movements associated with acute opioid toxicity. We develop algorithms and perform testing in two environments: (i) an approved supervised injection facility (SIF), where people self-inject illicit opioids, and (ii) the operating room (OR), where we simulate rapid, opioid-induced overdose events using routine induction of general anesthesia. In the SIF (n = 209), our system identified postinjection, opioid-induced central apnea with 96% sensitivity and 98% specificity and identified respiratory depression with 87% sensitivity and 89% specificity. These two key events commonly precede fatal opioid overdose. In the OR, our algorithm identified 19 of 20 simulated overdose events. Given the reliable reversibility of acute opioid toxicity, smartphone-enabled overdose detection coupled with the ability to alert naloxone-equipped friends and family or emergency medical services (EMS) could hold potential as a low-barrier, harm reduction intervention.

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“…The reviewed work demonstrates that patients at risk of opioid overdose presenting to the ED are willing to accept take-home naloxone, which is consistent with previous related research. 17 , 19 , 20 , 23 While the evidence regarding the effectiveness of the intervention is poor, one study reported that16% of patients who received naloxone kits went on to use it in the rescue of an opioid overdose. 23 Even with this potential for harm reduction and the acceptance among patients and providers, the practice of prescribing take-home naloxone was overall low.…”

Section: Discussionmentioning

confidence: 99%

The Emergency Department as an Opportunity for Naloxone Distribution

Gunn

Smothers

Schramm-Sapyta

et al. 2018

WestJEM

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IntroductionSubstance 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.MethodsWe 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.ResultsOf 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.ConclusionThis 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.

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Impacts of an opioid overdose prevention intervention delivered subsequent to acute care

Abstract: NCT0178830; Results.

Cited by 40 publications

References 34 publications

Fatal overdose prevention and experience with naloxone: A cross-sectional study from a community-based cohort of people who inject drugs in Baltimore, Maryland

Fatal overdose prevention and experience with naloxone: A cross-sectional study from a community-based cohort of people who inject drugs in Baltimore, Maryland

Opioid overdose detection using smartphones

The Emergency Department as an Opportunity for Naloxone Distribution

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