Overdose prevention for injection drug users: Lessons learned from naloxone training and distribution programs in New York City

Piper, Tinka Markham; Rudenstine, Sasha; Stancliff, Sharon; Sherman, Susan N.; Nandi, Vijay; Clear, Allan; Galea, Sandro

doi:10.1186/1477-7517-4-3

Cited by 52 publications

(29 citation statements)

References 15 publications

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“…Nonfatal overdose is associated with significant morbidity, including pneumonia, renal failure, mental impairment, and cardiac arrhythmia [20]. The strongest predictor of experiencing an overdose is prior overdose [20,21], with most users reporting multiple overdose experiences in their lifetime [18,21,22]. …”

Section: Introductionmentioning

confidence: 99%

HIV infection and risk of overdose

Green

McGowan

Yokell

et al. 2012

Aids

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Drug overdose is a common cause of non-AIDS death among people with HIV and the leading cause of death for people who inject drugs. People with HIV are often exposed to opioid medications during their HIV care experience; others may continue to use illicit opioids despite their disease status. In either situation, there may be a heightened risk for nonfatal or fatal overdose. The potential mechanisms for this elevated risk remain controversial. We systematically reviewed the literature on the HIV–overdose association, meta-analyzed results, and investigated sources of heterogeneity, including study characteristics related to hypothesize biological, behavioral, and structural mechanisms of the association. Forty-six studies were reviewed, 24 of which measured HIV status serologically and provided data quantifying an association. Meta-analysis results showed that HIV seropositivity was associated with an increased risk of overdose mortality (pooled risk ratio 1.74, 95% confidence interval 1.45, 2.09), although the effect was heterogeneous (Q = 80.3, P <0.01, I2 = 71%). The wide variability in study designs and aims limited our ability to detect potentially important sources of heterogeneity. Causal mechanisms considered in the literature focused primarily on biological and behavioral factors, although evidence suggests structural or environmental factors may help explain the greater risk of overdose among HIV-infected drug users. Gaps in the literature for future research and prevention efforts as well as recommendations that follow from these findings are discussed.

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Section: Introductionmentioning

confidence: 99%

HIV infection and risk of overdose

Green

McGowan

Yokell

et al. 2012

Aids

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“…1,26,27 Currently, practitioners find motivation to start services from the patient populations that they serve on a day-to-day basis, generally in pain management or substance abuse treatment practices and needle-exchange programs. 28-30 These providers found a need for an overdose prevention strategy that would directly benefit their patients and also work toward an over-arching goal of reducing deaths related to opioid overdose.…”

Section: Resultsmentioning

confidence: 99%

Naloxone for Opioid Overdose Prevention

Bailey

Wermeling

2014

Ann Pharmacother

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Background Deaths related to opioid overdose have increased in the past decade. Community-based pharmacy practitioners have worked toward overcoming logistic and cultural barriers to make naloxone distribution for overdose prevention a standard and accepted practice. Objective To describe outpatient naloxone dispensing practices, including methods by which practitioners implement dispensing programs, prescribing patterns that include targeted patient populations, barriers to successful implementation, and methods for patient education. Methods Interviews were conducted with providers to obtain insight into the practice of dispensing naloxone. Practitioners were based in community pharmacies or clinics in large metropolitan cities across the country. Results It was found that 33% of participating pharmacists practice in a community-pharmacy setting, and 67% practice within an outpatient clinic-based location. Dispensing naloxone begins by identifying patient groups that would benefit from access to the antidote. These include licit users of high-dose prescription opioids (50%) or injection drug users and abusers of prescription medications (83%). Patients were identified through prescription records or provider screening tools. Dispensing naloxone required a provider’s prescription in 5 of the 6 locations identified. Only 1 pharmacy was able to exercise pharmacist prescriptive authority within their practice. Conclusion Outpatient administration of intramuscular and intranasal naloxone represents a means of preventing opioid-related deaths. Pharmacists can play a vital role in contacting providers, provision of products, education of patients and providers, and dissemination of information throughout the community. Preventing opioid overdose–related deaths should become a major focus of the pharmacy profession.

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“…57 Ten strategies had a negligible or no impact on overdoses and deaths. 35,41,49,52,68,70,75,76,81,93 Five strategies had a small positive effect, 48,50,53,62,94 two had a moderate positive effect, 55,56 and four had a large positive effect, 60,63,69,82 which included (1) overdose prevention training and naloxone distribution, plus a change in the legal status of naloxone to permit its administration by any member of the public Most promising strategies by content and target audience Figure 5a and 5b show the impact of the strategies by content and target population. It suggests that the most promising strategies to improve appropriate use of opioids are (1) educational strategies aimed at health care professionals; (2) clinical strategies aimed at patients, opioid users, and health care professionals; and (3) collaborations.…”

Section: Impact On Overdose and Deathsmentioning

confidence: 99%

“…Among the 66 strategies described, 19 (29%) had some type of unintended consequence 41,42,[44][45][46]49,53,57,59,60,68,71,[73][74][75]79,82,84,90 and 4 reported no unintended consequence. 47,55,64,65 It was unclear in 43 studies whether there were any unintended consequences or not.…”

Section: Unintended Consequences Of Implemented Strategiesmentioning

confidence: 99%

“…Consequences that affected the target population of the strategy were reported, such as patients not receiving necessary prescriptions 71 ; patients paying for their prescriptions out of their own pockets 71 ; overdose due to rotation from other opioids to methadone 57,74 ; more overdose by morphine, hydromorphone, and heroine 68,75 ; stolen naloxone kits 53,60,82 ; being harassed by police over possession of naloxone 82 ; stigma associated with carrying a naloxone kit 60 ; stigma associated with receiving a prescription for addiction 79 ; a paradoxical increase in overdose because suspension of physicians who were prescribing improperly led to patients on withdrawal and overdosing from other sources 41 ; patients had a false sense of privilege because of participation in an educational session, leading to more opioid abuse 90 ; and possible beliefs that naloxone access enables addiction to opioids. 49 There were consequences to the staff involved in the implementation of strategies: extra burden on the clinical staff (pharmacists and/or physicians) 42,71 ; burden on pharmacy staff who had to assemble intranasal naloxone kits; or risks of needle stick injury to staff who had to assemble intramuscular naloxone.…”

Section: Unintended Consequences Of Implemented Strategiesmentioning

confidence: 99%

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A systematic review of strategies to improve appropriate use of opioids and to reduce opioid use disorder and deaths from prescription opioids

Furlan

Carnide

Irvin

et al. 2018

Canadian Journal of Pain

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Background: Abuse of prescription opioids is a serious problem in North America. Aims: The aim of this study was to conduct a systematic review of peer-reviewed and grey literature to examine existing strategies aimed at improving the appropriate use of prescription opioids and/or reducing the misuse, abuse, and diversion of these drugs. Methods: The following electronic databases were searched to September 2015 without language restrictions: MEDLINE, EMBASE, PsycINFO, and CINAHL; the grey literature was searched to May 2014. Reference lists of retrieved papers were also searched. Studies were eligible if a strategy was implemented and its impact on at least one of the primary outcomes of interest (appropriate prescription opioid use; misuse, abuse, opioid use disorder, diversion; overdose) was measured. Standardized, prepiloted forms were used for relevance screening, quality appraisal, and data extraction. Results: A total of 65 studies that assessed 66 distinct strategies were identified. Due to the heterogeneity of the strategies, a qualitative synthesis was conducted. Many studies combined more than one type of strategy and measured various types of outcomes. The strategies with most promising results involved education, clinical practices, collaborations, prescription monitoring programs, public campaigns, opioid substitution programs, and naloxone distribution. We also found strategies that had some unintended consequences after implementation. Conclusions: Our review identified successful strategies that have been implemented and evaluated in various jurisdictions. There is a need to replicate and disseminate these strategies where the problem of prescription opioid misuse and abuse has taken a toll on society.

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Overdose prevention for injection drug users: Lessons learned from naloxone training and distribution programs in New York City

Cited by 52 publications

References 15 publications

HIV infection and risk of overdose

HIV infection and risk of overdose

Naloxone for Opioid Overdose Prevention

A systematic review of strategies to improve appropriate use of opioids and to reduce opioid use disorder and deaths from prescription opioids

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