Abstract:In response to the growing public health problem of drug overdose, community-based organizations have initiated overdose prevention programs (OPP), which distribute naloxone, an opioid antagonist, and teach overdose response techniques. Injection drug users (IDUs) have been targeted for this intervention due to their high risk for drug overdose. Limited research attention has focused on factors that may inhibit or prevent IDUs who have been trained by OPPs to undertake recommended response techniques when resp… Show more
“…For the four studies of naloxone lay administration effectiveness (Strang et al 2008; Lankenau et al 2013; McAuley et al 2010; Galea et al 2006), the summary odds ratio measuring the strength of the association between naloxone administration and recovery based on the data reported was 8.58 (95% confidence interval (CI) = 3.90 to 13.25, I 2 = 92.09%), indicating a statistically significant but highly heterogeneous effect (see Figure 2). Figure 2Estimated odds ratios of recovery from drug overdose associated with naloxone administration by bystanders.…”
Section: Resultsmentioning
confidence: 99%
“…This was only relevant for the rating of the study by Lankenau et al (2013). This discrepancy can be attributed to slight differences in scoring.…”
The objective of this review was to assess the effectiveness of bystander naloxone administration and overdose education programs by synthesizing quantitative results reported in the research literature. Studies meeting predefined criteria were identified and reviewed, and their results were synthesized through meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for overdose recoveries for individuals who received naloxone dispensed by non-medical community members, and the standardized mean difference was calculated for test scores of non-medical volunteers who received training in overdose management versus the scores of untrained volunteers. Pooled data from four studies showed that naloxone administration by bystanders was associated with a significantly increased odds of recovery compared with no naloxone administration (OR = 8.58, 95% CI = 3.90 to 13.25). Data from five studies of overdose education indicated that average scores were significantly higher for trained participants than untrained participants for tests on naloxone administration, overdose recognition, and overdose response (standardized mean difference = 1.35, 95% CI = 0.92 to 1.77). Empirical evidence in the research literature suggests that bystander naloxone administration and overdose education programs are associated with increased odds of recovery and with improved knowledge of overdose recognition and management in non-clinical settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s40621-015-0041-8) contains supplementary material, which is available to authorized users.
“…For the four studies of naloxone lay administration effectiveness (Strang et al 2008; Lankenau et al 2013; McAuley et al 2010; Galea et al 2006), the summary odds ratio measuring the strength of the association between naloxone administration and recovery based on the data reported was 8.58 (95% confidence interval (CI) = 3.90 to 13.25, I 2 = 92.09%), indicating a statistically significant but highly heterogeneous effect (see Figure 2). Figure 2Estimated odds ratios of recovery from drug overdose associated with naloxone administration by bystanders.…”
Section: Resultsmentioning
confidence: 99%
“…This was only relevant for the rating of the study by Lankenau et al (2013). This discrepancy can be attributed to slight differences in scoring.…”
The objective of this review was to assess the effectiveness of bystander naloxone administration and overdose education programs by synthesizing quantitative results reported in the research literature. Studies meeting predefined criteria were identified and reviewed, and their results were synthesized through meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for overdose recoveries for individuals who received naloxone dispensed by non-medical community members, and the standardized mean difference was calculated for test scores of non-medical volunteers who received training in overdose management versus the scores of untrained volunteers. Pooled data from four studies showed that naloxone administration by bystanders was associated with a significantly increased odds of recovery compared with no naloxone administration (OR = 8.58, 95% CI = 3.90 to 13.25). Data from five studies of overdose education indicated that average scores were significantly higher for trained participants than untrained participants for tests on naloxone administration, overdose recognition, and overdose response (standardized mean difference = 1.35, 95% CI = 0.92 to 1.77). Empirical evidence in the research literature suggests that bystander naloxone administration and overdose education programs are associated with increased odds of recovery and with improved knowledge of overdose recognition and management in non-clinical settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s40621-015-0041-8) contains supplementary material, which is available to authorized users.
“…25, 31 Further regulatory or legislative action and community education/outreach to inform the public about their protections related to calling emergency services or administering naloxone may be necessary. 71 States increasingly recognize the importance of bystanders’ responding to overdose and are providing some immunity from arrest and/or prosecution for drug possession crimes and/or liability protection for administering naloxone.…”
Background
As physicians have increased opioid prescribing, overdose deaths from pharmaceutical opioids have substantially increased in the United States. Naloxone hydrochloride (naloxone), an opioid antagonist, is the standard of care for treatment of opioid induced respiratory depression. Since 1996, community-based programs have offered overdose prevention education and distributed naloxone for bystander administration to people who use opioids, particularly heroin. There is growing interest in translating overdose education and naloxone distribution (OEND) into conventional medical settings for patients who are prescribed pharmaceutical opioids. For this review, we summarized and classified existing publications on overdose education and naloxone distribution to identify evidence of effectiveness and opportunities for translation into conventional medical settings.
Methods
For this review, we searched English language PubMed for articles on naloxone based on primary data collection from humans, including feasibility studies, program evaluations, surveys, qualitative studies and studies comparing the effectiveness of different routes of naloxone administration. We also included cost-effectiveness studies.
Results
We identified 41 articles that represented 5 categories: evaluations of OEND programs, effects of OEND programs on experiences and attitudes of participants, willingness of medical providers to prescribe naloxone, comparisons of different routes of naloxone administration, and the cost-effectiveness of naloxone.
Conclusions
Existing research suggests that people who are at risk for overdose and other bystanders are willing and able to be trained to prevent overdoses and administer naloxone. Counseling patients about the risks of opioid overdose and prescribing naloxone is an emerging clinical practice which may reduce fatalities from overdose while enhancing the safe prescribing of opioids.
“…In private homes, overdose prevention may fall to different groups of bystanders, friends, relatives, or caregivers, or their responses may differ. For instance, in private locations, which would include homes, bystanders may not call for emergency services after giving naloxone (Lankenau et al, 2013). Given the short duration of action of naloxone, a return of opioid intoxication from an OPR with a longer duration of action, might then lead to fatal rebound respiratory distress.…”
Introduction
Prescription opioid pain reliever overdose is a major public health issue in the United States. To characterize the location of drug-related deaths, we examined fatal prescription opioid and illicit drug-related deaths reported in 12 states.
Methods
Data are from the Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network (DAWN). Medical examiners or coroners in 12 states (MA, MD, ME, NH, NM, OK, OR, RI, UT, VA, VT, WV) reported details of state-wide drug-related mortality during 2008–2010. DAWN data included location and manner of death, age, race, and drugs involved. Deaths were coded into three categories: prescription opioid-related, illicit drug-related, and cases that involved both a prescription opioid and an illicit drug.
Results
During a 3-year period, there were 14,091 opioid or illicit drug-related deaths in 12 states. More than half of the prescription opioid-related deaths in all states, except Maryland, occurred at home, rather than in public or in a health care facility. Although it was still the predominant category, lower percentages of illicit drug-related deaths occurred at home.
Conclusion
Prescription opioid overdoses have increased substantially, and the location of the person at the time of death can have important public health implications for interventions.
Practical applications
This paper highlights that bystander support can be a critical lifesaving factor in drug related deaths but may be more likely for illicit drug-related deaths than for prescription opioid-related deaths.
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