A longitudinal study of naloxone opioid overdose awareness and reversal training for first-year medical students: specific elements require reinforcement

Abstract

Background The opioid epidemic is a progressively worsening public health crisis that continues to impact healthcare system strategies such as overdose reversal and destigmatization. Even among healthcare professionals, there remains a lack of confidence in naloxone administration and a prevalence of stigma. While training can play a major impact in reducing these shortcomings, the long-term effectiveness has yet to be characterized in training healthcare professionals. This study examined the long-term retention of opioid overdose awareness and reversal training (OOART) by evaluating performance at two-time intervals, immediately post-training and at a 3-month follow-up. Methods Voluntary training was offered to first-year (M1) medical students at the Drexel University College of Medicine in 2021. At this training, 118 students completed training, 95 completed the post-training survey, and 42 completed the 3-month follow-up. Results Opioid reversal knowledge questions assessed significantly increased scores post-training and at the 3-month follow-up. In three of the attitude questions, scores were improved at both follow-up timepoints. In addition, three attitude questions indicating a participant’s confidence to respond to an opioid overdose situation increased directly after the training, but regressed at the 3-month follow-up. The remaining questions did not show any statistical difference across the survey intervals. Conclusions This study establishes that while OOART provides participants with the knowledge of how to respond to an opioid overdose, the retention of this knowledge at a 3-month interval is reduced. The results were mixed for longitudinal assessment of participant’s attitudes toward people with opioid use disorder. Some positive increases in attitudes were retained at the 3-month interval, while others trended back toward pre-training levels. These results support the effectiveness of the training but also provide evidence that OOART must be reinforced often.

Optimizing buprenorphine training during undergraduate medical education: Medical student feedback and attitudes

“…Nonetheless, we hypothesize that the decrease in subjective preparedness to respond to an overdose may have arisen from students' increased awareness about knowledge gaps and potential risks of naloxone (e.g., precipitated withdrawal). This finding echoes that of Sandhu et al, 38 who found regression of improvement in confidence about responding to an opioid overdose 3 months after an OOPR training, a finding they attributed to students' self‐awareness of knowledge lost. This knowledge awareness could foster agreement with limiting naloxone access because students also indicated concern that patients should receive guidance and information before receiving multiple naloxone doses.…”

“…Nonetheless, we hypothesize that the decrease in subjective preparedness to respond to an overdose may have arisen from students' increased awareness about knowledge gaps and potential risks of naloxone (e.g., precipitated withdrawal). This finding echoes that of Sandhu et al, 38 who found regression of improvement in confidence about would be useful and less than a third thought they would use the waiver. These findings align with existing physician buprenorphine prescribing behavior.…”

Assessment of the acute‐ and long‐term application of naloxone training on a simulated overdose response

“…Similar data has been seen when looking at non‐pharmacy students. Sandhu and colleagues 19 described naloxone training for first‐year medical students using opioid overdose awareness and reversal training, an educational method detailed in the medical education literature as being effective in increasing naloxone prescribing rates 20 . A survey that assessed student knowledge and perceived self‐efficacy in responding with naloxone was administered immediately following the training and again 3 months later.…”

ReportNeedles.ca: A real-time needle collection tool to foster community health partnerships

“…Naloxone training is a brief, educational harm reduction intervention comprised of distribution of naloxone alongside information about opioids, safer drug use, overdose risk and symptoms, and medication administration. [17][18][19] These trainings have been found to significantly increase knowledge regarding safer substance use amongst people who use drugs, service providers, and the public. [17][18][19] Naloxone can reverse a potentially fatal opioid overdose and can be administered by anyone, [17][18][19] however training is required to ensure proper implementation.…”

“…[17][18][19] These trainings have been found to significantly increase knowledge regarding safer substance use amongst people who use drugs, service providers, and the public. [17][18][19] Naloxone can reverse a potentially fatal opioid overdose and can be administered by anyone, [17][18][19] however training is required to ensure proper implementation. 18 Additionally, harm reduction peer support groups will be offered by APSS to active drug users that focus on psychoeducation, enhancing participant support networks, and knowledge of safer drug use.…”