Can we prevent drug related deaths by training opioid users to recognise and manage overdoses?

Abstract

Background: Naloxone has been evidenced widely as a means of reducing mortality resulting from opiate overdose, yet its distribution to drug users remains limited. However, it is drug users who are most likely to be available to administer naloxone at the scene and who have been shown to be willing and motivated to deliver this intervention. The current study builds on a national training evaluation in England by assessing 6-month outcome data collected primarily in one of the participating centres.

What is known about community pharmacy supply of naloxone? A scoping review

“…One study conducted in the UK found reductions in heroin use following naloxone training (Gaston, Best, Manning, & Day, 2009). This suggests such concerns may be unfounded, and addressing these unfounded perceptions may be important as part of pharmacist education.…”

A systematic review of strategies to improve appropriate use of opioids and to reduce opioid use disorder and deaths from prescription opioids

“…57 Ten strategies had a negligible or no impact on overdoses and deaths. 35,41,49,52,68,70,75,76,81,93 Five strategies had a small positive effect, 48,50,53,62,94 two had a moderate positive effect, 55,56 and four had a large positive effect, 60,63,69,82 which included (1) overdose prevention training and naloxone distribution, plus a change in the legal status of naloxone to permit its administration by any member of the public Most promising strategies by content and target audience Figure 5a and 5b show the impact of the strategies by content and target population. It suggests that the most promising strategies to improve appropriate use of opioids are (1) educational strategies aimed at health care professionals; (2) clinical strategies aimed at patients, opioid users, and health care professionals; and (3) collaborations.…”

“…Among the 66 strategies described, 19 (29%) had some type of unintended consequence 41,42,[44][45][46]49,53,57,59,60,68,71,[73][74][75]79,82,84,90 and 4 reported no unintended consequence. 47,55,64,65 It was unclear in 43 studies whether there were any unintended consequences or not.…”

“…Consequences that affected the target population of the strategy were reported, such as patients not receiving necessary prescriptions 71 ; patients paying for their prescriptions out of their own pockets 71 ; overdose due to rotation from other opioids to methadone 57,74 ; more overdose by morphine, hydromorphone, and heroine 68,75 ; stolen naloxone kits 53,60,82 ; being harassed by police over possession of naloxone 82 ; stigma associated with carrying a naloxone kit 60 ; stigma associated with receiving a prescription for addiction 79 ; a paradoxical increase in overdose because suspension of physicians who were prescribing improperly led to patients on withdrawal and overdosing from other sources 41 ; patients had a false sense of privilege because of participation in an educational session, leading to more opioid abuse 90 ; and possible beliefs that naloxone access enables addiction to opioids. 49 There were consequences to the staff involved in the implementation of strategies: extra burden on the clinical staff (pharmacists and/or physicians) 42,71 ; burden on pharmacy staff who had to assemble intranasal naloxone kits; or risks of needle stick injury to staff who had to assemble intramuscular naloxone.…”

Toxicology from across the pond

“…These include concerns that many overdoses occur alone, addicts will be unable to recognise and respond to overdose, inappropriate use of naloxone may lead to complications or delay definitive care, some treated patients will be able to refuse care that is desperately needed, physicians will be reluctant to prescribe naloxone, and by making drug use safer overall use will increase. 25,35,36 Although the majority of these concerns have been discussed and settled in previous eras, they continue to resurface, possibly as a result of societal pressures and rooted belief systems.…”