Overdose Prevention and Naloxone Prescription for Opioid Users in San Francisco

Abstract

Opiate overdose is a significant cause of mortality among injection drug users (IDUs) in the United States (US). Opiate overdose can be reversed by administering naloxone, an opiate antagonist. Among IDUs, prevalence of witnessing overdose events is high, and the provision of take-home naloxone to IDUs can be an important intervention to reduce the number of overdose fatalities. The Drug Overdose Prevention and Education (DOPE) Project was the first naloxone prescription program (NPP) established in partnership with a county health department (San Francisco Department of Public Health), and is one of the longest running NPPs in the USA. From September 2003 to December 2009, 1,942 individuals were trained and prescribed naloxone through the DOPE Project, of whom 24% returned to receive a naloxone refill, and 11% reported using naloxone during an overdose event. Of 399 overdose events where naloxone was used, participants reported that 89% were reversed. In addition, 83% of participants who reported overdose reversal attributed the reversal to their administration of naloxone, and fewer than 1% reported serious adverse effects. Findings from the DOPE Project add to a growing body of research that suggests that IDUs at high risk of witnessing overdose events are willing to be trained on overdose response strategies and use take-home naloxone during overdose events to prevent deaths.

Opioid Overdose Deaths in the City and County of San Francisco: Prevalence, Distribution, and Disparities

“…27 The reasons for this reduction may be related to both the introduction of Btreatment-on-demand,^with improved access to opioid agonist maintenance therapy, and broad distribution of naloxone, the short-acting opioid antagonist, to heroin users. 38 The Drug Overdose Prevention and Education Project distributed naloxone to over 4000 persons from 2003 to 2012 and documented 449 opioid overdose reversals from 2010 to 2012. Over 91 % of these reversed overdoses were due to heroin, suggesting that naloxone distribution, based largely on syringe exchange programs, reached heroin users rather than prescription opioid users.…”

“…Deaths were clustered largely within the Tenderloin/Civic Center (32.5 %) and South of Market (12.4 %) neighborhoods, both of which have a high proportion of residents living in poverty, single room occupancy hotels, and opioid-related drug arrests. [36][37][38] While 44.9 % of opioid-related deaths occurred in these two neighborhoods, remaining deaths were diffused throughout the city, with 35 of 37 neighborhoods recording at least one opioid overdose death (Appendix Table 1). The visualizations of opioid overdoses as points and elevation maps can be seen in Figs.…”

Development and Implementation of an Opioid Overdose Prevention and Response Program in Toronto, Ontario

“…San Francisco's program reported 6 deaths over 75 months. 10 This description of the POINT program highlights its novelty and innovation in the Canadian setting, and other public health units might learn from its development and implementation process. Our program development process may also be useful to programs and services outside of public health as well, including methadone treatment programs, discharge planning in emergency departments, drug treatment programs, and prison settings.…”

Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff

“…6 Program evaluations suggest that community-based overdose education and naloxone distribution is an effective strategy to prevent overdose fatalities. [7][8][9][10][11][12] Community-based programs have traditionally served people who use heroin and nonmedical opioids, but a significant proportion of overdose deaths are related to opioids prescribed for pain. [13][14][15][16][17] In the Veteran's Administration and large managed care organizations, the overdose risk is particularly high in people prescribed more than 100 milligrams morphine equivalent daily doses.…”