Training family members to manage heroin overdose and administer naloxone: randomized trial of effects on knowledge and attitudes

Williams, Anna; Marsden, John; Strang, John

doi:10.1111/add.12360

Cited by 90 publications

(84 citation statements)

References 39 publications

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“…Correctly tailored treatment is therefore even more important when AUD or PD co-exist with the OUD. Additionally, specific anti-overdose harm reduction measures such as overdose training for family and peers in overdose management (Williams et al, 2014) and pre-provision of emergency naloxone (Strang et al, 2008) should be provided and would save lives. This study highlights the importance of assessment for PD and AUD in OUD patients in order to identify individuals at substantially elevated mortality risk to enable a more personalized approach to their medical care.…”

Section: Discussionmentioning

confidence: 99%

Double trouble: Psychiatric comorbidity and opioid addiction—All-cause and cause-specific mortality

Bogdanowicz¹,

Stewart²,

Broadbent³

et al. 2015

Drug and Alcohol Dependence

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Section: Discussionmentioning

confidence: 99%

Double trouble: Psychiatric comorbidity and opioid addiction—All-cause and cause-specific mortality

Bogdanowicz¹,

Stewart²,

Broadbent³

et al. 2015

Drug and Alcohol Dependence

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“…Evidence shows that clients of syringe exchange programs demonstrated the ability to successfully reverse overdoses when they had been provided with naloxone and training (73). In addition, providing family members of opioid-addicted individuals and nonparamedic first responders with naloxone may be an effective strategy for rescuing overdose victims (21,90). At present, there are more than 188 community-based naloxone distribution programs in 15 states and the District of Columbia (11).…”

Section: Tertiary Preventionmentioning

confidence: 99%

The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

Kolodny

Courtwright

Hwang

et al. 2015

Annu. Rev. Public Health

1,177

870

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Public health authorities have described, with growing alarm, an unprecedented increase in morbidity and mortality associated with use of opioid pain relievers (OPRs). Efforts to address the opioid crisis have focused mainly on reducing nonmedical OPR use. Too often overlooked, however, is the need for preventing and treating opioid addiction, which occurs in both medical and nonmedical OPR users. Overprescribing of OPRs has led to a sharp increase in the prevalence of opioid addiction, which in turn has been associated with a rise in overdose deaths and heroin use. A multifaceted public health approach that utilizes primary, secondary, and tertiary opioid addiction prevention strategies is required to effectively reduce opioid-related morbidity and mortality. We describe the scope of this public health crisis, its historical context, contributing factors, and lines of evidence indicating the role of addiction in exacerbating morbidity and mortality, and we provide a framework for interventions to address the epidemic of opioid addiction.

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“…With work coordinated by Anna Williams, we have undertaken a randomized trial testing the immediate-and medium-term gains in knowledge and increased confidence in overdose management, using new measures to assess gains in knowledge and attitude [39] and demonstrating the extent of gain of knowledge and confidence and its robustness over time [40] (see Fig. 6).…”

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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Training family members to manage heroin overdose and administer naloxone: randomized trial of effects on knowledge and attitudes

Abstract: Take-home naloxone training for family members of heroin users increases opioid overdose-related knowledge and competence and these benefits are well retained after 3 months.

Cited by 90 publications

References 39 publications

Double trouble: Psychiatric comorbidity and opioid addiction—All-cause and cause-specific mortality

Double trouble: Psychiatric comorbidity and opioid addiction—All-cause and cause-specific mortality

The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

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

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