Naloxone Administration by Untrained Community Members

Abstract

Study ObjectiveAccess to naloxone is a priority for reducing opioid deaths. Although community members who complete naloxone training are able to administer nasal naloxone successfully and rapidly, little is known about the ability of community members to administer naloxone without training. The objective of this study was to assess the ability of untrained individuals to administer naloxone successfully in a simulated opioid overdose setting.DesignProspective single‐site open‐label randomized usability assessment.SettingScenario station at a large state fair during August and September 2017.ParticipantsA total of 207 healthy adults who were randomly assigned to administer naloxone using a nasal spray (NS) device (69 participants), an intramuscular (IM) kit (68 participants), or an improvised nasal atomizer (AT) kit (70 participants).InterventionParticipants were instructed to administer the device to a high‐fidelity mannequin in a public environment with distractions to mimic those that might be present in an actual overdose. No device instructions or administration materials were provided.Measurements and Main ResultsParticipants were assessed by trained study team members who directly observed all naloxone administrations using the predetermined end‐point criteria. Individual participant perceptions were evaluated immediately following the naloxone administration using a standardized questionnaire form. The primary outcome was successful administration, defined as administration within 7 minutes and without critical errors. Secondary outcomes were time to successful naloxone administration and ease of use of the device. The NS (66.7%, p<0.001) and IM (51.5%, p<0.001) devices had higher rates of successful administration than the improvised nasal AT device (2.9%). The NS device was administered more rapidly (median 16 sec) than the IM device (median 58 sec, p<0.001) or improvised nasal AT device (median 113 sec, p=0.012) devices, and it was the easiest to use.ConclusionIn this study of naloxone administration, participants administered the NS and IM devices more successfully than the AT device. The NS device was administered most rapidly and was easiest to use.

Multi-informant Implementation and Intervention Outcomes of Opioid Overdose Education and Naloxone Distribution in New York City

“…Because direct observations of laypersons behavior in real overdose situations are generally not feasible, due to the unpredictable nature of overdoses, some researchers have attempted to measure overdose response proficiency (i.e., how well laypersons are able to translate what they have learned during training into behavior) in a simulated overdose situation. These studies indicate variations in the ability of trained laypersons to administer naloxone (Eggleston et al, 2018 , 2020 ). While our study and others have shown that commonly used OEND practices lead to improved opioid overdose knowledge and attitudes toward overdose management (Clark et al, 2014 ; European Monitoring Centre for Drugs & Drug Addiction, 2015 ; McDonald & Strang, 2016 ), continued research addressing the gap between intended or anticipated behavior and actual behavior is required to clarify the real-world implications of these outcomes.…”

The use and effectiveness of high-fidelity simulation in health professions education: current update

“…The participants were able to conclude that the nasal spray formulation of naloxone was the most successfully administered in an opioid overdose. 19 Crucial data obtained with the aid of HFS confirm the benefits of its utilization not only in teaching, but also in obtaining information to better advance emergency management and public health.…”

Mobilizing pharmacists to address the opioid crisis: A joint opinion of the ambulatory care and adult medicine practice and research networks of the American College of Clinical Pharmacy

“…28 Two recently approved products using each of these routes of administration have been shown to have advantages regarding ease of use and may thus be preferable when increased cost is not a barrier. [29][30][31][32] When used, naloxone can restore normal respiration and consciousness in the overdose victim. 11 Improving access to naloxone has become a national priority endorsed by the Surgeon General, and every state has enacted at least one naloxone access law (NAL) to achieve this goal.…”

“…Currently, naloxone is available in several formulations appropriate for administration by a layperson, such as intranasal or intramuscular routes 28 . Two recently approved products using each of these routes of administration have been shown to have advantages regarding ease of use and may thus be preferable when increased cost is not a barrier 29‐32 . When used, naloxone can restore normal respiration and consciousness in the overdose victim 11 .…”