Where Next for Opioids and the Law? Despair, Harm Reduction, Lawsuits, and Regulatory Reform

Burris, Scott

doi:10.1177/0033354917743500

Cited by 12 publications

(4 citation statements)

References 34 publications

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“…The trainer workshops lasted 4 h and covered: [1] background and rationale for the SL program, [2] mechanisms of an OD, [3] identifying and responding to an OD, [4] effects of naloxone, [5] assembling the naloxone kit and administrating the naloxone, [6] pulmonary resuscitation [PR] using a standard reanimation “AmbuMan” training mannequin, [7] project documentation, and [8] implementation procedures at the local sites.…”

Section: Methodsmentioning

confidence: 99%

“…Further, the SL project coordinator (a registered nurse) supervised the trainers when they conducted their first helper workshop. The helper workshop lasted 1 h, involved 5–6 participants, and covered [1] participant experience with ODs and risk behavior [2]; introduction to the naloxone kit and intranasal spray [3]; resuscitation training.…”

Section: Methodsmentioning

confidence: 99%

“…Many countries struggle with how to deal with opioid dependence, which often lead to fatal opioid overdoses [OD] [1]. Such events may be the result of the misuse of prescription opioid drugs [2] or may occur during opioid agonist maintenance treatment [3, 4].…”

Section: Introductionmentioning

confidence: 99%

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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

Thylstrup¹,

Hesse²,

Jørgensen³

et al. 2019

Harm Reduct J

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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

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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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

Thylstrup¹,

Hesse²,

Jørgensen³

et al. 2019

Harm Reduct J

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“…(12,13) In the United States, common harm reduction strategies include syringe services programs (SSPs) to reduce risk of injection-associated infections (14)(15)(16)(17); overdose education and naloxone distribution (OEND) to prevent fatal overdose (18,19); and low-barrier access to medications for opioid use disorder (MOUD) to facilitate patient engagement in care and reduce mortality. (20)(21)(22) Although harm reduction services are highly evidence-based and effective, their implementation in most healthcare settings has been limited, in part due to federal legislation (23,24). Under current models, the vast majority of harm reduction services are provided through community-based public health organizations.…”

mentioning

confidence: 99%

Utilizing Implementation Science to Identify Barriers and Facilitators to Implementing Harm Reduction Services in the Veterans Health Administration (VHA)

Harvey

Sliwiński

Flike

et al. 2022

Preprint

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Background: Rising rates of substance use, particularly the use of synthetic opioids, have led to increases in fatal overdoses and injection-associated infections. Harm reduction, including infection prevention via provision of educational interventions and sterile syringes and other supplies, is an approach to minimize risk of severe outcomes. Although harm reduction services (HRS) are highly evidence-based, implementation in most healthcare settings has been limited. The aim of this study was to identify facilitators and barriers to the implementation of HRS to inform strategies for increasing access and facilitating the adoption of a comprehensive bundle of harm reduction resources within the VHA. Methods:Qualitative interviews were conducted using a semi-structured interview guide. Interviews explored how harm reduction is currently understood and implemented by VHA providers and elicited input on perceived facilitators and barriers to implementation. Data were analyzed using a directed content analysis. After barriers and facilitators were identified, they were mapped to relevant implementation strategies using the Consolidated Framework for Implementation Research - Expert Recommendations for Implementing Change (CFIR – ERIC) tool. Results:15 interviews with VHA providers (physicians, social workers, pharmacists, and directors of addiction and mental health services) were conducted across 5 sites. Multiple barriers and few facilitators to the provision of HRS were identified. Existing HRS were thought to be fragmented and dependent on the knowledge, time, and comfort level of individual providers. Participants also highlighted stigma around substance use, limited support, and burdensome regulatory requirements. Existing infrastructure, social programming, and local champions were highlighted as facilitators. Given these factors, implementation strategies that may be bundled to promote adoption of HRS include engagement of champions, communications and educational strategies, existing policies, and creation of dashboards, tracking, and feedback systems. Conclusions: HRS are effective and evidence-based, yet their adoption into traditional healthcare settings has been limited. Mapping of barriers to evidence-based implementation strategies may help improve integration of HRS into VHA healthcare, however, challenges addressing stigma remain a substantial barrier. More research is needed to identify implementation strategies that are most effective for addressing barriers imposed by stigma.

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Protecting Workers from Opioid Misuse and Addiction

Rosen¹

2021

Emerging Issues in Family and Individual Resilience

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Where Next for Opioids and the Law? Despair, Harm Reduction, Lawsuits, and Regulatory Reform

Cited by 12 publications

References 34 publications

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

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

Utilizing Implementation Science to Identify Barriers and Facilitators to Implementing Harm Reduction Services in the Veterans Health Administration (VHA)

Protecting Workers from Opioid Misuse and Addiction

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