Modeling of overdose and naloxone distribution in the setting of fentanyl compared to heroin

Coffin, Phillip O.; Maya, Sigal; Kahn, James G.

doi:10.1016/j.drugalcdep.2022.109478

Cited by 10 publications

(8 citation statements)

References 58 publications

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“…Fentanyl dependence can complicate buprenorphine starts and increase overdose rates and therefore may impact our intervention and outcomes. We will discuss the impacts of this potential confounding in our outcomes paper [ 32 , 35 ]. Additionally, there were no measures of fidelity for the CBMF program or systematic quantification of receipt of services by individual participant (e.g., to measure a dose–response effect).…”

Section: Discussionmentioning

confidence: 99%

“…The target enrollment number is based upon an estimated annual non-fatal opioid overdose rate of 10% documented in emergency medical care records; the actual occurrence of non-fatal heroin overdose is approximately 20% [ 29 ] with approximately half seeking acute medical care during a serious overdose (unpublished data from the Washington State naloxone distribution project participant surveys managed by SK). Unfortunately, the fatal overdose rate locally and nationally has increased rapidly coinciding with increased fentanyl availability [ 30 , 31 ], and overdose rates among those with a history of OUD may be much higher than when heroin was the predominant opioid [ 32 ]. The power calculation for detecting a difference in the proportions 10% vs 6.3% (37% reduction based upon Larochelle and colleagues [ 3 ]) results in 855 people in the intervention group for a confidence interval of 95% for a 2-sided test and 80% power to detect a significant difference.…”

Section: Methodsmentioning

confidence: 99%

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The Community-Based Medication-First program for opioid use disorder: a hybrid implementation study protocol of a rapid access to buprenorphine program in Washington State

Banta‐Green

Owens

Williams

et al. 2022

Addict Sci Clin Pract

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Background Opioid use disorder (OUD) is a serious health condition that is effectively treated with buprenorphine. However, only a minority of people with OUD are able to access buprenorphine. Many access points for buprenorphine have high barriers for initiation and retention. Health care and drug treatment systems have not been able to provide services to all—let alone the majority—who need it, and many with OUD report extreme challenges starting and staying on buprenorphine in those care settings. We describe the design and protocol for a study of a rapid access buprenorphine program model in six Washington State communities at existing sites serving people who are unhoused and/or using syringe services programs. This study aimed to test the effectiveness of a Community-Based Medication-First Program model. Methods We are conducting a hybrid effectiveness-implementation study of a rapid access buprenorphine model of care staffed by prescribers, nurse care managers, and care navigators. The Community-Based Medication-First model of care was designed as a 6-month, induction-stabilization-transition model to be delivered between 2019 and 2022. Effectiveness outcomes will be tested by comparing the intervention group with a comparison group derived from state records of people who had OUD. Construction of the comparison group will align characteristics such as geography, demographics, historical rates of arrests, OUD medication, and health care utilization, using restriction and propensity score techniques. Outcomes will include arrests, emergency and inpatient health care utilization, and mortality rates. Descriptive statistics for buprenorphine utilization patterns during the intervention period will be documented with the prescription drug monitoring program. Discussion Results of this study will help determine the effectiveness of the intervention. Given the serious population-level and individual-level impacts of OUD, it is essential that services be readily available to all people with OUD, including those who cannot readily access care due to their circumstances, capacity, preferences, and related systems barriers.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The Community-Based Medication-First program for opioid use disorder: a hybrid implementation study protocol of a rapid access to buprenorphine program in Washington State

Banta‐Green

Owens

Williams

et al. 2022

Addict Sci Clin Pract

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“…In addition, SSP participants are typically at high risk for either experiencing or witnessing an opioid overdose. Engaging SSP participants in OEND is critical; fentanyl-involved overdoses occur rapidly, and naloxone must be administered quickly to prevent mortality [ 14 , 20 ]. SSPs first integrated OEND in 1996 [ 21 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

Best practices for community-based overdose education and naloxone distribution programs: results from using the Delphi approach

Wenger

Doe-Simkins²,

Wheeler³

et al. 2022

Harm Reduct J

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Background Opioid-related overdose deaths have surged in the USA over the last two decades. Overdose fatalities are preventable with the timely administration of naloxone. Syringe service programs (SSP) have pioneered community-based naloxone distribution through overdose prevention and naloxone distribution (OEND) programs. There is a dearth of information with regards to best practices for community-based OEND. Methods We utilized a modified Delphi approach to develop a set of best practices for OEND delivery. Starting with an initial list of best practices, we engaged 27 experts, in the field of OEND programming who reviewed, made recommendations for changes, and assigned a priority to each best practice. Results Two rounds of input resulted in a final list of 20 best practices organized into four categories. The mean priority scores ranged from 1.17 to 2.17 (range 1 to 3). The top 5 ranked best practices were ensuring that SSP participants have low barrier, consistent, needs-based access to naloxone and that there is ample naloxone available within communities. While the remaining fifteen best practices were deemed important, they had more to do with organizational culture and implementation climate. Conclusions Increasing community-based OEND delivery is essential to reduce opioid overdose deaths; however, it will be insufficient to add programs without an eye toward quality of implementation and fidelity to the model upon which the evidence is based. This list of best practices summarizes the consensus among OEND experts and can serve as a tool for SSPs providing OEND programming to improve services.

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“…Providing naloxone to laypeople who may witness an opioid overdose is highly effective at preventing overdose mortality [ 6 - 10 ]; however, the rapidity of fentanyl overdose limits the time frame in which naloxone can be effectively administered. Therefore, additional and complementary opioid overdose interventions are urgently needed [ 11 ]. Motivational interviewing has been shown to reduce opioid risk behaviors [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“There’s No Heroin Around Anymore. It’s All Fentanyl.” Adaptation of an Opioid Overdose Prevention Counseling Approach to Address Fentanyl Overdose: Formative Study

McMahan¹,

Arenander²,

Matheson³

et al. 2022

JMIR Form Res

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Background Drug overdose mortality continues to increase, now driven by fentanyl. Prevention tools such as naloxone and medications to treat opioid use disorder are not sufficient to control overdose rates; additional strategies are urgently needed. Objective We sought to adapt a behavioral intervention to prevent opioid overdose (repeated-dose behavioral intervention to reduce opioid overdose [REBOOT]) that had been successfully piloted in San Francisco, California, United States, to the setting of Boston, Massachusetts, United States, and the era of fentanyl for a full efficacy trial. Methods We used the assessment, decision, adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework for intervention adaptation. We first identified opioid overdose survivors who were actively using opioids as the population of interest and REBOOT as the intervention to be adapted. We then performed theater testing and elicited feedback with 2 focus groups (n=10) in Boston in 2018. All participants had used opioids that were not prescribed to them in the past year and experienced an opioid overdose during their lifetime. We incorporated focus group findings into our initial draft of the adapted REBOOT intervention. The adapted intervention was reviewed by 3 topical experts, and their feedback was integrated into a subsequent draft. We trained study staff on the intervention and made final refinements based on internal piloting. This paper describes the overall ADAPT-ITT process for intervention adaptation, as well as a qualitative analysis of the focus groups. Working independently, 2 authors (VMM and JA) reviewed the focus group transcripts and coded them for salient and common themes using the constant comparison method, meeting to discuss any discrepancies until consensus was reached. Codes and themes were then mapped onto the REBOOT counseling steps. Results Focus group findings contributed to substantial changes in the counseling intervention to better address fentanyl overdose risk. Participants described the widespread prevalence of fentanyl and said that, although they tried to avoid it, avoidance was becoming impossible. Using alone and lower opioid tolerance were identified as contributors to overdose risk. Slow shots or tester shots were acceptable and considered effective to reduce risk. Naloxone was considered an effective reversal strategy. Although calling emergency services was not ruled out, participants described techniques to prevent the arrival of police on the scene. Expert review and internal piloting improved the intervention manual through increased participant centeredness, clarity, and usability. Conclusions We successfully completed the ADAPT-ITT approach for an overdose prevention intervention, using theater testing with people who use opioids to incorporate the perspectives of people who use drugs into a substance use intervention. In the current crisis, overdose prevention strategies must be adapted to the context of fentanyl, and innovative strategies must be deployed, including behavioral interventions. Trial Registration ClinicalTrials.gov NCT03838510; https://clinicaltrials.gov/ct2/show/NCT03838510

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Modeling of overdose and naloxone distribution in the setting of fentanyl compared to heroin

Cited by 10 publications

References 58 publications

The Community-Based Medication-First program for opioid use disorder: a hybrid implementation study protocol of a rapid access to buprenorphine program in Washington State

The Community-Based Medication-First program for opioid use disorder: a hybrid implementation study protocol of a rapid access to buprenorphine program in Washington State

Best practices for community-based overdose education and naloxone distribution programs: results from using the Delphi approach

“There’s No Heroin Around Anymore. It’s All Fentanyl.” Adaptation of an Opioid Overdose Prevention Counseling Approach to Address Fentanyl Overdose: Formative Study

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