Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time–series analysis

McAuley, Andrew; Bouttell, Janet; Barnsdale, Lee; Mackay, Daniel; Lewsey, Jim; Hunter, Carole; Robinson, Mark

doi:10.1111/add.13602

Cited by 23 publications

(16 citation statements)

References 27 publications

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“…Ambulance call‐outs for overdoses within a pre‐determined time‐frame post‐THN receipt are suggestive of increased opioid use. However, ambulance calls are an important and expected aspect of THN distribution, administration and after‐care.…”

Section: Measuring Unintended Consequences Of Thnmentioning

confidence: 99%

Should we worry that take‐home naloxone availability may increase opioid use?

et al. 2019

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Section: Measuring Unintended Consequences Of Thnmentioning

confidence: 99%

Should we worry that take‐home naloxone availability may increase opioid use?

et al. 2019

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“…Research has additionally indicated that peers trained in overdose response may continue to use non-evidence-based strategies alongside recommended strategies [18,21,36] and that they may be deterred from using naloxone because it can prompt withdrawal symptoms which make victims aggressive ('over-antagonism') [37]. Furthermore, studies have suggested that THN might reduce ambulance call-outs resulting in fatalities from the recurrence of respiratory depression if lay responders leave victims unattended [18,[38][39][40], although this has also been refuted [15,41,42].…”

Section: Introductionmentioning

confidence: 99%

How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies

et al. 2018

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Background and Aims Providing take-home naloxone (THN) to people who use opioids is an increasingly common strategy for reversing opioid overdose. However, implementation is hindered by doubts regarding the ability of people who use opioids to administer naloxone and respond appropriately to overdoses. We aimed to increase understanding of the competencies required and demonstrated by opioid users who had recently participated in a THN programme and were subsequently confronted with an overdose emergency. Design Qualitative study designed to supplement findings from a randomized controlled trial of overdose education and naloxone distribution. Interviews were audio-recorded, transcribed, systematically coded and analysed via Iterative Categorization. Setting New York City, USA. Participants Thirty-nine people who used opioids (32 men, 7 women; aged 22-58 years). Intervention Trial participants received brief or extended overdose training and injectable or nasal naloxone. Measurements The systematic coding frame comprised deductive codes based on the topic guide and more inductive codes emerging from the data. Findings In 38 of 39 cases the victim was successfully resuscitated; the outcome of one overdose intervention was unknown. Analyses revealed five core overdose response 'tasks': (1) overdose identification; (2) mobilizing support; (3) following basic first aid instructions; (4) naloxone administration; and (5) post-resuscitation management. These tasks comprised actions and decisions that were themselves affected by diverse cognitive, emotional, experiential, interpersonal and social factors over which lay responders often had little control. Despite this, participants demonstrated high levels of competency. They had acquired new skills and knowledge through training and brought critical 'insider' understanding to overdose events and the resuscitation actions which they applied. Conclusions People who use opioids can be trained to respond appropriately to opioid overdoses and thus to save their peers' lives. Overdose response requires both practical competency (e.g. skills and knowledge in administering basic first aid and naloxone) and social competency (e.g. willingness to help others, having the confidence to be authoritative and make decisions, communicating effectively and demonstrating compassion and care to victims post-resuscitation).

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“…Future studies will need to look at the extent to which widespread THN provision, as perhaps achieved in Scotland McAuley et al, 2017), Norway (MadahAmiri et al, 2017) and several states in the US (Walley et al, 2013), results in reduction in opioid overdose mortaliy at state or national level, and what naloxone coverage rates are required to achieve this effect.…”

Section: Naloxone Coveragementioning

confidence: 99%

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

McDonald

Campbell

Strang

2017

Drug and Alcohol Dependence

117

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Highlights Deaths from opioid overdose can be prevented by prompt administration of naloxone  It has been 20 years since take-home naloxone provision was first proposed  Take-home naloxone programs have recently overcome legal barriers in many countries  Take-home naloxone provision remains low compared to evident growing clinical need  The 'opt-out' model of required pre-provision may achieve wider naloxone coverage Abstract Background: Opioid overdose is a major cause of mortality, but injury and fatal outcomes can be prevented by timely administration of the opioid antagonist naloxone. Pre-provision of naloxone to opioid users and family members (take-home naloxone, THN) was first proposed in 1996, and WHO Guidelines were issued in 2014. While widespread in some countries, THN is minimally available or absent elsewhere. This review traces the development of THN over twenty years, from speculative harm reduction proposal to public health strategy.Method: Medline and PsycINFO were searched for peer-reviewed literature using Boolean queries: 1) "naloxone OR Narcan"; 2) "(opioid OR opiate) AND overdose AND prevention". Grey literature and specialist websites were also searched. Data were extracted and synthesized as narrative review, with key events presented as chronological timeline. Results Conclusions:Framed as a public health tool for harm reduction, THN has overcome social, clinical, and legal barriers in many jurisdictions. Nonetheless, the rising death toll of opioid overdose illustrates that current THN coverage is insufficient, and greater public investment in overdose prevention will be required if THN is to achieve its full potential impact.

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Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time–series analysis

Cited by 23 publications

References 27 publications

Should we worry that take‐home naloxone availability may increase opioid use?

Should we worry that take‐home naloxone availability may increase opioid use?

How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

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