Peer overdose resuscitation: multiple intervention strategies and time to response by drug users who witness overdose

Best, David; Gossop, Michael; Man, Lan‐Ho; Stillwell, Garry; Coomber, Ross; Strang, John

doi:10.1080/0959523021000002732

Cited by 23 publications

(26 citation statements)

References 16 publications

(25 reference statements)

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“…We also examined the circumstances of these overdoses, and found that more than three-quarters of overdoses occurred in a home situation and in the company of others (see Table 2) [31,32], hence apparently suitable for the training and naloxone provision that we were considering. We also conducted 'market research'-pre-launch testing of the acceptability of the proposed intervention with the target population of drug users themselves-and found high levels of approval and interest [32,33] and also high levels of previous active intervention, even though the interventions were often wrong [33][34][35].…”

Section: Before Trainingmentioning

confidence: 99%

Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths

Strang

2015

Addiction

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Aims To describe work undertaken over a 20-year period, investigating overdose characteristics among survivors, effects of acute heroin administration, clustering of risk of overdose fatality and potential interventions to reduce this fatal outcome. Methods Privileged-access interviewers obtained data from non-treatment as well as treatment samples; experimental study of drop in oxygen saturation following heroin/opiate injection; investigation of clusterings of death following prison release and treatment termination; and study of target populations as intervention work-force, including family as well as peers, and action research built into pilot implementation. Results Overdose has been experienced by about half of heroin/opiate misusers, with even higher proportions having witnessed an overdose, and with high levels of willingness to intervene. Heroin/opiates are associated with the majority of drug-related deaths, despite relative scarcity of use. Heroin injection causes a rapid drop in oxygen saturation, recovering only slowly over the next half hour. Deaths from drug overdose are greatly more likely on prison release and post-discharge from detoxification and other in-patient or residential settings. High levels of declared willingness to intervene are matched by active interventions. Both drug-using peers and family members show ability to improve knowledge and gain confidence from training. Audit study of take-home schemes finds approximately 10% of dispensed naloxone is used in real-life emergency situations.Conclusions Overdose is experienced by most users, with heroin/opiates contributing disproportionately to drug overdose deaths. High-risk times (e.g. after prison release) are now clearly identified. Peers and family are a willing potential intervention work-force, but are rarely trained or given pre-supply of naloxone. Large-scale naloxone provision (e.g. national across Scotland and Wales) is now being delivered, while large-scale randomized trials (e.g. N-ALIVE prison-release trial) are finally under way. Better naloxone products and better-organized provision are needed. The area does not need more debate; it now needs proper implementation alongside good scientific study.

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Section: Before Trainingmentioning

confidence: 99%

Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths

Strang

2015

Addiction

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“…Survey-based studies have indicated that the prevalence of witnessing among drug users may range between 24% and 94% (Baca and Grant, 2007; Bennett and Higgins, 1999; Best et al, 2002; Davidson et al, 2002; Kaye and Darke, 2004; Pollini et al, 2006a; Tracy et al, 2005). These data suggest that drug users may frequently be witnesses at the overdoses of other drug users.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of drug users who witness many overdoses: Implications for overdose prevention

Bohnert

Tracy

Galea

2012

Drug and Alcohol Dependence

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Background Programs to improve response of drug users when witnessing an overdose can reduce overdose mortality. Characteristics of drug users may be associated with the number of overdoses ever witnessed. This information could inform overdose prevention programs. Methods Participants in New York City, who were age 18 and older with heroin and/or with cocaine use in the past two months, were administered structured interviews (n = 1,184). Survey topics included overdose response, drug use behavior, treatment history, and demographic information. Results In a multivariable negative binomial regression model, those persons who are male (IRR [Incidence Rate Ratio] = 1.7, CI [95% Confidence Interval] = 1.4,2.2), have experienced homelessness (IRR = 1.9, CI= 1.4,2.6), have used heroin (IRR = 2.0, CI = 1.3,3.2), have overdosed themselves (IRR = 1.9, CI = 1.6,2.4), and have attended Narcotics Anonymous (IRR = 1.3, CI = 1.1,1.6) witnessed a greater count of overdoses in their lifetime. Those persons who have witnessed more overdoses were less likely to have sought medical assistance (OR [Odds Ratio] = 0.7) and more likely to report counter-productive or ineffective actions (ORs between 1.9 and 2.4) at the last overdose they witnessed compared to persons who had only ever witnessed one or two overdoses. Conclusions Persons at high risk for overdose are likely to witness more overdoses. Persons who had witnessed more overdoses were more likely to report taking ineffective action at the last overdose witnessed; individuals who have witnessed many overdoses are likely key targets of overdose response training.

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“…Given that many drug overdoses are never reported to emergency health services, drug users themselves may be made aware of overdose problems before anyone else becomes alerted to them. Although most overdoses are witnessed by others, bystanders will delay or neglect to seek appropriate medical assistance for reasons such as fear of arrest [37,38]. Studies indicate that many overdoses do not involve calling the ambulance or going to the hospital.…”

Section: Discussionmentioning

confidence: 99%

It's time for Canadian community early warning systems for illicit drug overdoses

Fielden

Marsh

2007

Harm Reduct J

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Although fatal and non-fatal overdoses represent a significant source of morbidity and mortality, current systems of surveillance and communication in Canada provide inadequate measurement of drug trends and lack a timely response to drug-related hazards. In order for an effective early warning system for illicit drug overdoses to become a reality, a number of elements will be required: real-time epidemiologic surveillance systems for illicit drug trends and overdoses, inter-agency networks for gathering data and disseminating alerts, and mechanisms for effectively and respectfully engaging with members of drug using communities. An overdose warning system in an urban area like Vancouver would ideally be imbedded within a system that monitors drug trends and overdoses by incorporating qualitative and quantitative information obtained from multiple sources. Valuable information may be collected and disseminated through community organizations and services associated with public health, emergency health services, law enforcement, medical laboratories, emergency departments, community-based organizations, research institutions and people with addiction themselves. The present paper outlines considerations and conceptual elements required to guide implementation of such systems in Canadian cities such as Vancouver.

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Peer overdose resuscitation: multiple intervention strategies and time to response by drug users who witness overdose

Cited by 23 publications

References 16 publications

Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths

Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths

Characteristics of drug users who witness many overdoses: Implications for overdose prevention

It's time for Canadian community early warning systems for illicit drug overdoses

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