Aims-This study assessed overdose and naloxone administration knowledge among current or former opioid abusers trained and untrained in overdose-response in the United States.Design and participants-Ten individuals, divided equally between those trained or not trained in overdose recognition and response, were recruited from each of six sites (n = 62).Setting-US-based overdose training and naloxone distribution programs in Baltimore, San Francisco, Chicago, New York and New Mexico.Measurements-Participants completed a brief questionnaire on overdose knowledge that included the task of rating 16 putative overdose scenarios for: (i) whether an overdose was occurring and (ii) if naloxone was indicated. Bivariate and multivariable analyses compared results for those trained to untrained. Responses were also compared to those of 11 medical experts using weighted and unweighted kappa statistics.Findings-Respondents were primarily male (72.6%); 45.8% had experienced an overdose and 72% had ever witnessed an overdose. Trained participants recognized more opioid overdose scenarios accurately (t 60 = 3.76, P < 0.001) and instances where naloxone was indicated (t 59 = 2.2, P < 0.05) than did untrained participants. Receipt of training and higher perceived competency in recognizing signs of an opioid overdose were associated independently with higher overdose recognition scores. Trained respondents were as skilled as medical experts in recognizing opioid overdose situations (weighted kappa = 0.85) and when naloxone was indicated (kappa = 1.0). Conclusions-Resultssuggest that naloxone training programs in the United States improve participants' ability to recognize and respond to opioid overdoses in the community. Drug users with overdose training and confidence in their abilities to respond may effectively prevent overdose mortality.

This study examines whether individuals who engage in illicit, non-medical use of OxyContin are distinguishable from other non-medical users of opioids and whether OxyContin serves as a "gateway" to heroin and/or injection drug use. The study sample included active nonmedical users of opioids, who are 16 years or older and residents of Cumberland County, Maine. Possible associations between type of opioid used and behavioral and descriptive variables were assessed. The study sample was predominantly urban-dwelling, male, Caucasian, and economically disadvantaged. OxyContin users could only be distinguished from heroin users (cf non-heroin opioid users). Polyopioid use within the first year of initiation was associated with quicker progression to heroin and injection drug use.

Increased hepatitis awareness among IDUs is necessary for reducing hepatitis transmissions. Although SEPs continue to effectively disseminate HIV prevention messages-as evidenced by lowered risk behaviors among their customers-they must do more to prevent hepatitis transmissions.