Neighborhood-Level & Spatial Characteristics Associated with Lay Naloxone Reversal Events & Opioid Overdose Deaths

There were over 23,000 opioid overdose deaths in the USA in 2013, and opioid-related mortality is increasing. Increased access to naloxone, particularly through community-based lay naloxone distribution, is a widely supported strategy to reduce opioid overdose mortality; however, little is known about the ecological and spatial patterns of the distribution and utilization of lay naloxone. 

This study aims to investigate the neighborhood-level correlates and spatial relationships of lay naloxone distribution and utilization and opioid overdose deaths. We determined the locations of lay naloxone distribution sites and the number of unintentional opioid overdose deaths and reported reversal events in San Francisco census tracts (n = 195) from 2010 to 2012. 

We used Wilcoxon rank-sum tests to compare census tract characteristics across tracts adjacent and not adjacent to distribution sites and multivariable negative binomial regression models to assess the association between census tract characteristics, including distance to the nearest site, and counts of opioid overdose deaths and naloxone reversal events. 

Three hundred forty-two opioid overdose deaths and 316 overdose reversals with valid location data were included in our analysis. Census tracts including or adjacent to a distribution site had higher income inequality, lower percentage black or African American residents, more drug arrests, higher population density, more overdose deaths, and more reversal events (all p < 0.05). 

In multivariable analysis, greater distance to the nearest distribution site (up to a distance of 4000 m) was associated with a lower count of Naloxone reversals [incidence rate ratio (IRR) = 0.51 per 500 m increase, 95% CI 0.39-0.67, p < 0.001] but was not significantly associated with opioid overdose deaths. 

These findings affirm that locating lay naloxone distribution sites in areas with high levels of substance use and overdose risk facilitates reversals of opioid overdoses in those immediate areas but suggests that alternative delivery methods may be necessary to reach individuals in other areas with less concentrated risk.

Purchase full article at:   http://goo.gl/V40N93

By:  Rowe C1, Santos GM2,3, Vittinghoff E3, Wheeler E4, Davidson P5, Coffin PO2,3.

• 1San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA. chris.rowe@sfdph.org.
• 2San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA.
• 3University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, USA.
• 4Drug Overdose Prevention and Education Project, Harm Reduction Coalition, 1440 Broadway, Suite 902, Oakland, CA, 94612, USA.
• 5University of California, San Diego, 9500 Gilman Drive, La Jolla, California, CA, 92093, USA. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Correlates of Overdose Risk Perception among Illicit Opioid Users

BACKGROUND:

Opioid-related mortality continues to increase in the United States. The current study assesses demographic and behavioral predictors of perceived overdose risk among individuals who use opioids illicitly. By examining these correlates in the context of established overdose risk factors, we aim to assess whether characteristics and behaviors that have been associated with actual overdose risk translate to higher perception of risk.

METHODS:

We conducted a cross-sectional survey of 172 adult illicit opioid users in San Francisco, CA and used multivariable logistic regression to identify predictors of perception of high risk for opioid overdose.

RESULTS:

Age (aOR=0.96, 95%CI=0.93-1.00) and number of injection days per month (0.91, 0.86-0.97) were associated with a lower odds of perceived high overdose risk. There was no independent association between use of opioid analgesics, concurrent use of opioids and benzodiazepines or cocaine, or HIV status and overdose risk perception.

CONCLUSIONS:

Opioid users who injected more frequently and those who were older were less likely to perceive themselves as being at risk of overdose, notwithstanding that those who inject more are at higher risk of overdose and those who are older are at higher risk overdose mortality. In addition, despite being established overdose risk factors, there was no relationship between use of opioid analgesics, concurrent use of opioids and cocaine or benzodiazepines, or self-reported HIV status and overdose risk perception. These findings highlight key populations of opioid users and established risk factors that may merit focused attention as part of education-based overdose prevention and opioid management strategies.

Purchase full article at:   http://goo.gl/guoVZL

By:  Rowe C1, Santos GM2, Behar E3, Coffin PO2.

• 1San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA. Electronic address: chris.rowe@sfdph.org.
• 2San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA.
• 3San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA. 
• Drug Alcohol Depend. 2015 Dec 30. pii: S0376-8716(15)01833-5. doi: 10.1016/j.drugalcdep.2015.12.018. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

What are opioids:  http://goo.gl/ncoQ9R 

Evaluation of Overdose Prevention Trainings in NYC: Knowledge and Self-Efficacy among Participants Twelve Months after Training

BACKGROUND:

Prevention of unintentional opioid overdose deaths is effective through overdose prevention trainings (OPTs), in which laypersons are taught overdose response through six actions. This longitudinal study examines trainee knowledge twelve months after OPT completion.

METHODS:

We enrolled participants following OPT at six sites. At twelve months follow-up, participants were asked to: name the drug overdoses that naloxone reverses; name overdose response actions. We created a 6-point scale comprised of number of correct overdose response actions mentioned (check breathing; administer sternum rub; call 911; give rescue breathing; administer naloxone; put victim in recovery position). We compared mean knowledge by participant sociodemographic characteristics, confidence, and site of OPT training (indoors versus outdoors).

RESULTS:

273 of 344 OPT participants were reached at twelve months. Nearly all (99%) participants identified that naloxone reverses heroin; 77% opioid analgesics; and 68% methadone overdoses. Overdose response actions most frequently mentioned were giving naloxone (86%) and calling 911 (76%). The remaining four actions were mentioned by less than 40% of participants. Overall mean knowledge score was 2.7 out of 6. Mean knowledge scores were higher for college graduates than those with less than college education (3.2 vs 2.6, p<0.001), for those who felt very confident (mean score (ms) = 2.9), compared to somewhat confident (ms = 2.4) and a little or not at all confident (ms = 1.5) in their ability to reverse an overdose (p<.001), and for indoor-training recipients (3.0 vs 2.5, p = 0.02). There were no differences in mean knowledge scores for trainees by age, race, or gender.

CONCLUSIONS:

Our findings suggest the need for several improvements in OPT curriculum, including emphasis on naloxone reversal of opioid analgesic and methadone overdoses, and all 6 rescue actions. Lower knowledge scores among outdoor-trained participants likely reflect session brevity, suggesting that outdoor trainings need to be enhanced.

Purchase full article at:   http://goo.gl/TOc94R

By:  Maldjian L1, Siegler A1, Kunins HV1.

• 1a Department of Health and Mental Hygiene , Bureau of Alcohol and Drug Use Prevention, Care and Treatment , Queens , NY , USA.
• Subst Abus. 2016 Jan 5:0

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Patient Perspectives on an Opioid Overdose Education and Naloxone Distribution Program in the US Department of Veterans Affairs

BACKGROUND:

In an effort to prevent opioid overdose mortality among Veterans, Department of Veterans Affairs (VA) facilities began implementing Opioid Overdose Education and Naloxone Distribution (OEND) in 2013 and a national program began in 2014. VA is the first national health care system to implement OEND. The goal of this study is to examine patient perceptions of OEND training and naloxone kits.

METHODS:

Four focus groups were conducted between December 2014 and February 2015 with 21 patients trained in OEND. Participants were recruited from a VA residential facility in California with a substance use disorder treatment program (mandatory OEND training) and a homeless program (optional OEND training). Data were analyzed using matrices and open and closed coding approaches to identify what participants liked and did not like, group discussion disagreements, and suggestions for improvement.

RESULTS:

Veterans thought OEND training was interesting, novel, and empowering, and that naloxone kits will save lives. Some veterans expressed concern about using syringes in the kits. A few patients who never used opioids were not interested in receiving kits. Veterans had differing opinions about legal and liability issues, whether naloxone kits might contribute to relapse, and whether and how to involve family in training. Some veterans expressed uncertainty about the effects of naloxone. Suggested improvements included active learning approaches, enhanced training materials, and increased advertisement.

CONCLUSIONS:

OEND training was generally well-received among study participants, including those with no indication for a naloxone kit. Patients described a need for OEND and believed it could save lives. Patient feedback on OEND training benefits, concerns, opinions, and suggestions provides important insights to inform future OEND training programs both within VA and in other health care settings. Training is critical to maximizing the potential for OEND to save lives and this study includes specific suggestions for improving the effectiveness and acceptability of training.

Purchase full article at:   http://goo.gl/JfkPlb

By:  Oliva EM1, Nevedal A1, Lewis ET1,2, McCaa MD1, Cochran MF1,3, Konicki PE4,5, Davis CS6, Wilder C7,8.

• 1 VA Palo Alto Health Care System - Center for Innovation to Implementation , Menlo Park , CA , USA.
• 2 VA Office of Mental Health Operations - Program Evaluation and Resource Center , Menlo Park , CA , USA.
• 3 Stanford University School of Medicine - Department of Psychiatry and Behavioral Sciences , Stanford , CA , USA.
• 4 Louis Stokes Cleveland VA Medical Center , Cleveland , OH , USA.
• 5 Case Western Reserve University School of Medicine - Department of Psychiatry , Cleveland , OH , USA.
• 6National Health Law Program , Los Angeles , CA , USA.
• 7 Cincinnati VA Medical Center , Cincinnati , OH , USA.
• 8 University of Cincinnati College of Medicine - Department of Psychiatry and Behavioral Neuroscience , Cincinnati , OH , USA.
• Subst Abus. 2015 Dec 16:0. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Extended-Release Naltrexone: A Qualitative Analysis of Barriers to Routine Use

Highlights

• The Consolidated Framework for Implementation Research structured a qualitative analysis of features of extended-release naltrexone that inhibited use for the treatment of alcohol and opioid use disorders.
• The processes of ordering, storing, and using and the cost of extended-release naltrexone were characteristics of the intervention that reduced use.
• Features of the outer setting (environment) that inhibited use included requirements for patients with opioid use disorders to be opioid free for 7 to 10 days and health plan formulary, benefit management, and reimbursement policies.
• Program cultures, resistance to change, and weak linkages with primary care for ongoing injections also affected routine use of the medication.

The Medication Research Partnership (a national health plan and nine addiction treatment centers contracted with the health plan) sought to facilitate the adoption of pharmacotherapy for alcohol and opioid use disorders. Qualitative analysis of interviews with treatment center change leaders, individuals working for the manufacturer and its technical assistance contractor, and health plan managers extracted details on the processes used to order, store, bill for, and administer extended-release naltrexone. Qualitative themes were categorized using domains from the Consolidated Framework for Implementation Research (intervention characteristics, outer setting, inner setting, and provider characteristics).

Characteristics of XR-NTX that inhibited use included the complexity of ordering and using the medication; cost was also a barrier. Outer setting barriers reflected patient needs and external health plan policies on formulary coverage, benefit management, and reimbursement. Program structures, the lack of physician linkages, a culture resistant to the use of medication, and unease with change were inner setting elements that limited use of XR-NTX. Patient stereotypes and a lack of knowledge about XR-NTX affected practitioner willingness to treat patients and prescribe XR-NTX. The Consolidated Framework for Implementation Research provided a useful lens to understand and interpret the processes affecting access to XR-NTX.

Purchase full article at:   http://goo.gl/CHlchu

By:   Kelly Alanis-Hirsch, P.hD.,  Raina Croff, Ph.D., James H. Ford II, Ph.D., Kim Johnson, Ph.D., Mady Chalk, Ph.D., Laura Schmidt, Ph.D., Dennis McCarty, Ph.D.

Affiliations

OHSU-PSU School of Public Health, Oregon Health & Science University

Correspondence

Corresponding author at: OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239. Tel.: +503 494 1177.

mccartyd@ohsu.edu

DOI: http://dx.doi.org/10.1016/j.jsat.2015.10.003

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Shop Amazon - Kindle Book Deals

Worldwide Prevalence and Trends in Unintentional Drug Overdose: A Systematic Review of the Literature

Drug overdose is an important, yet an inadequately understood, public health problem. Global attention to unintentional drug overdose has been limited by comparison with the scope of the problem. There has been a substantial increase in drug overdose incidence and prevalence in several countries worldwide over the past decade, contributing to both increased costs and mortality.

The aim of this study was to systematically synthesize the peer-reviewed literature to document the global epidemiological profile of unintentional drug overdoses and the prevalence, time trends, mortality rates, and correlates of drug overdoses. We searched different combinations of Medical Subject Headings (MeSH) terms in PubMed for articles published from 1980 until July 2013, and we organized these results in tabular spreadsheets and compared them. We restricted the search to English-language articles that deal with unintentional overdose, focusing on 1 or more of the following key constructs: prevalence, time trends, mortality rates, and correlates. The term "overdose" as a MeSH major topic yielded 1076 publications. In addition, we searched the following combinations of nonmajor MeSH terms: "street drugs" and "overdose" yielded 180, "death" and "overdose" yielded 114, and "poisoning" and "drug users" yielded 17. There was some overlap among the searches. Based on the search and inclusion and exclusion criteria, we selected a total of 169 relevant articles for this article based on a close review of abstracts.

We found wide variability in lifetime prevalence of experiencing a nonfatal overdose or witnessing an overdose, and in mortality rates attributable to overdose. Lifetime prevalence of witnessed overdose among drug users (n = 17 samples) ranged from 50% to 96%, with a mean of 73.3%, a median of 70%, and a standard deviation of 14.1%. Lifetime prevalence of drug users personally experiencing a nonfatal overdose (n = 27 samples), ranged from 16.6% to 68.0% with a mean of 45.4%, a median of 47%, and a standard deviation of 14.4%. Population-based crude overdose mortality rates (n = 28 samples) ranged from 0.04 to 46.6 per 100 000 person-years. This range is likely attributable to the diversity in regions, time periods, and samples. Most studies on longitudinal trends of overdose death rates or overdose-related hospitalization rates showed increases in overdose death rates and in overdose-related hospitalization rates across time, which have led to peaks in these rates at the present time. An overall trend of increasing deaths from prescription opioid use and decreasing deaths from illicit drug use in the past several years has been noted across most of the literature. With the increase in prescription opioid overdose deaths, drug overdose is not just an urban problem: rural areas have seen an important increase in overdose deaths. Lastly, cocaine, prescription opioids, and heroin are the drugs most commonly associated with unintentional drug overdoses worldwide and the demographic and psychiatric correlates associated with unintentional drug overdoses are similar globally.

There is a need to invest in research to understand the distinct determinants of prescription drug overdose worldwide. Several other countries need to collect in a systematic and continuous fashion such data on sales of prescription opioids and other prescription drugs, nonmedical use of prescription drugs, and hospitalization secondary to overdoses on prescription drugs. The sparse evidence on the environmental determinants of overdose suggests a need for research that will inform the types of environmental interventions we can use to prevent drug overdose. Methodological issues for future studies include enhancing data collection methods on unintentional fatal and nonfatal overdoses, and collecting more detailed information on drug use history, source of drug use (for prescription drugs), and demographic and psychiatric history characteristics of the individual who overdosed.

Purchase full article at: http://goo.gl/qz9e4H

By: Martins SS, Sampson L, Cerdá M, Galea S.

  

More at:  https://twitter.com/hiv_insight