One opioid user saving another: the first study of an opioid overdose-reversal and naloxone distribution program addressing hard-to-reach drug scenes in Denmark

Abstract

BackgroundOverdose education and naloxone distribution programs decrease opioid overdose deaths. However, no studies of such programs have been carried out in Denmark. The aim of this study was to evaluate the feasibility and the effect of a broader “training-the-trainers” model in low-threshold settings after participation in the “Danish Save Lives” [SL] program.MethodsBetween May 2013 and November 2015, 552 participants from four municipalities took part in the SL program. The program is built on the train-the-trainers model where a central trainer trains others (trainers), who in turn train others (helpers). Participants were 30 police officers (5%), 188 people who use opioids (34%), 23 significant others (4%), and 217 social workers (39%). Ninety-four participants could not be classified (17%). At follow-up, participants were interviewed to determine the number and outcomes of opioid overdoses. Logistic regression was used to assess predictors of treating an overdose.ResultsIn all, 37 (7%) participants had intervened in 45 opioid overdose events (two trainers and 35 helpers). Detailed descriptions of the overdose event were available from 32 follow-up interviews (70%). In 16 cases, the person who intervened was already present at the site when the overdose occurred, and in 17 cases, the overdose victim recovered without complications. All overdose victims survived except one. People who used opioids were more likely to have treated an overdose than other participants (adjusted odds ratio [AOR] = 8.50, p = 0.001), and the likelihood of treating and overdose declined over time AOR = 0.37 (0.13, 0.93), p = 0.034).ConclusionsPrevention programs that target people who use opioids are more likely to be effective than programs that target professionals, especially in high-risk settings that can be hard for paramedics to reach. A future goal is to explore how prevention programs can be adapted to new user groups.Trial registrationThe Danish Data Protection Agency, 2015-57-0002, Aarhus University, 2016-051-000001, 184, retrospectively registered

Characteristics of and Experience Among People Who Use Take-Home Naloxone in Skåne County, Sweden

“…Research has shown that previous experiences of own overdose, or being witness to someone else's overdose, is frequently reported among OPEND participants ( 27 , 28 ). PWUO themselves are more likely to report naloxone administration while responding to a suspected opioid overdose (henceforth referred to as an overdose reversal), compared to other groups ( 29 , 30 ). PWUO at risk of own overdose have shown to be more involved in networks of individuals with similar lifestyles and are thus more likely to witness and act upon overdoses ( 16 , 29 , 31 ).…”

“…PWUO at risk of own overdose have shown to be more involved in networks of individuals with similar lifestyles and are thus more likely to witness and act upon overdoses ( 16 , 29 , 31 ). In addition, previous experience of having witnessed overdose(s), having used heroin ( 29 , 31 ) or methamphetamine ( 31 ), have been found to be associated with naloxone refill and reports of reversals, suggesting that the primary OPEND focus should be to reach at-risk populations ( 29 , 30 ). Overdose management, and especially seeking emergency medical assistance (EMA), has shown to vary in different settings and populations.…”

A longitudinal study of naloxone opioid overdose awareness and reversal training for first-year medical students: specific elements require reinforcement

“…One method of addressing the opioid overdose crisis is improved access to naloxone, a lifesaving opioid overdose reversal medication, in health care settings and communities with high rates of opioid overdose [ 18 – 20 ]. Naloxone standing orders allow anybody to obtain naloxone from a pharmacy without a prescription from a physician, and their implementation has had a demonstrable positive impact [ 21 – 23 ].…”

Danish cannabis policy revisited: Multiple framings of cannabis use in policy discourse

“…In Denmark, the introduction of a medical cannabis trial has thus not fundamentally altered the general position of cannabis in Danish policy (debates), as, for instance, illustrated by the parliament’s recent rejections of legalisation proposals. Due to the fact that most cannabis policy areas in Denmark are today coloured by repressive control thinking, discussions and initiatives aimed at harm reduction, which are currently prevalent in relation to, for example, heroin users ( Houborg & Frank, 2014 ; Thylstrup et al, 2019 ), are also almost non-existent in relation to cannabis and cannabis users.…”