Naloxone use among overdose prevention trainees in New York City: A longitudinal cohort study

Siegler, Anne; Huxley-Reicher, Zina; Maldjian, Lara; Jordan, Robyn; Oliver, C. Gatius; Jakubowski, Andrea; Kunins, Hillary V.

doi:10.1016/j.drugalcdep.2017.06.029

Cited by 26 publications

(22 citation statements)

References 17 publications

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“…In June 2014, there were roughly 644 OENDPs operating in 30 states and the District of Columbia [4], but this number has likely expanded given the gravity of the current epidemic. The DOPE project and community partners provide most naloxone kits to PWUD because they are more likely to be present at an overdose and administer naloxone [12,13].…”

Section: Discussionmentioning

confidence: 99%

Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015

Rowe

Wheeler

Jones³

et al. 2018

J Urban Health

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This report documents a successful intervention by a community-based naloxone distribution program in San Francisco. The program and its partner organizations, working with participants who use drugs, first identified the appearance of illicitly made fentanyl and increased outreach and naloxone distribution. Distribution of naloxone and reported use of naloxone to reverse opioid-involved overdoses increased significantly while the number of opioid-involved and fentanyl-involved overdose deaths did not. Community-based programs that provide training and naloxone to people who use drugs can serve as an early warning system for overdose risk and adaptively respond to the rapidly changing overdose risk environment.

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Section: Discussionmentioning

confidence: 99%

Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015

Rowe

Wheeler

Jones³

et al. 2018

J Urban Health

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“…Prior to training, the consulting physician asked the patient if they had any history of witnessing an overdose, a personal history of opioid overdose, or if they had received OEND previously. 18 The training consisted of a 12-minute video from the New York City Department of Health and Mental Hygiene played on a mobile computer (in English or Spanish) which covered overdose prevention through addressing modifiable risk factors, how to identify and respond to a suspected overdose, and how to assemble the kit and administer naloxone. Upon completion of the video, the consulting physician answered all questions and provided a teach-back, in which the patient was asked to describe what they would do step by step if they witnessed someone experiencing an overdose.…”

Section: Methodsmentioning

confidence: 99%

Development and Evaluation of a Pilot Overdose Education and Naloxone Distribution Program for Hospitalized General Medical Patients

et al. 2019

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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. Results Overall, consults on 80 patients were received. Of these, 74 were eligible and the consult team successfully trained 50 (68%). Current opioid analgesic use of ≥50 morphine milligram equivalents daily was the most common eligibility criterion met (38%). Twenty-four percent of patients were admitted for an opioid-related adverse event, the most common being opioid overdose (9%), then opioid withdrawal (8%), skin complication related to injecting (5%), and opioid intoxication (2%). Twenty-five percent had experienced an overdose, 35% had witnessed an overdose in their lifetime, and 83% had never received OEND previously. Conclusions Integrating OEND into general inpatient medical care is possible and can reach high-risk patients that have not received OEND previously. Future research should identify the optimal way of implementing this service.

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Section: Introductionmentioning

confidence: 99%

“…Research on THN programs has shown that THN kits are frequently used by people who use drugs to respond to overdoses [7, 8]. Specifically, approximately 25% of people who use drugs who are trained and supplied with naloxone will use it to reverse an overdose within 1 year [7]. At the population-level, reductions in overdose mortality have been observed following the implementation of THN programs, and higher rates of kit distribution lead to greater reductions in mortality [9, 10].…”

Section: Introductionmentioning

confidence: 99%

Patient characteristics associated with being offered take home naloxone in a busy, urban emergency department: a retrospective chart review

O’Brien

Dabbs

Dong

et al. 2019

BMC Health Serv Res

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Background Overdose deaths can be prevented by distributing take home naloxone (THN) kits. The emergency department (ED) is an opportune setting for overdose prevention, as people who use opioids frequently present for emergency care, and those who have overdosed are at high risk for future overdose death. We evaluated the implementation of an ED-based THN program by measuring the extent to which THN was offered to patients presenting with opioid overdose. We analyzed whether some patients were less likely to be offered THN than others, to identify areas for program improvement. Methods We retrospectively reviewed medical records from all ED visits between April 2016 and May 2017 with a primary diagnosis of opioid overdose at a large, urban tertiary hospital located in Alberta, Canada. A wide array of patient data was collected, including demographics, opioid intoxicants, prescription history, overdose severity, and whether a naloxone kit was offered and accepted. Multivariable analyses were used to identify patient characteristics and situational variables associated with being offered THN. Results Among the 342 ED visits for opioid overdose, THN was offered in 49% ( n = 168) of cases. Patients were more likely to be offered THN if they had been found unconscious (Adjusted Odds Ratio 3.70; 95% Confidence Interval [1.63, 8.37]), or if they had smoked or injected an illegal opioid (AOR 6.05 [2.15,17.0] and AOR 3.78 [1.32,10.9], respectively). In contrast, patients were less likely to be offered THN if they had a current prescription for opioids (AOR 0.41 [0.19, 0.88]), if they were admitted to the hospital (AOR 0.46 [0.22,0.97], or if they unexpectedly left the ED without treatment or before completing treatment (AOR 0.16 [0.22, 0.97). Conclusions In this real-world evaluation of an ED-based THN program, we observed that only half of patients with opioid overdose were offered THN. ED staff readily identify patients who use illegal opioids or experience a severe overdose as potentially benefitting from THN, but may miss others at high risk for future overdose. We recommend that hospital EDs provide additional guidance to staff to ensure that all eligible patients at risk of overdose have access to THN.

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Naloxone use among overdose prevention trainees in New York City: A longitudinal cohort study

Cited by 26 publications

References 17 publications

Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015

Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015

Development and Evaluation of a Pilot Overdose Education and Naloxone Distribution Program for Hospitalized General Medical Patients

Patient characteristics associated with being offered take home naloxone in a busy, urban emergency department: a retrospective chart review

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