scholarly journals Adverse events related to bystander naloxone administration in cases of suspected opioid overdose in British Columbia: An observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0259126
Author(s):  
Amina Moustaqim-Barrette ◽  
Kristi Papamihali ◽  
Sierra Williams ◽  
Max Ferguson ◽  
Jessica Moe ◽  
...  
Keyword(s):  
British Columbia ◽  
Adverse Events ◽  
Withdrawal Symptoms ◽  
Opioid Overdose ◽  
Real World Data ◽  
Naloxone Administration ◽  
Severe Withdrawal ◽  
Policy Program ◽  
Bystander Naloxone ◽  
Overdose Deaths

Introduction Take-Home Naloxone programs have been introduced across North America in response to rising opioid overdose deaths. There is currently limited real-world data on bystander naloxone administration, overdose outcomes, and evidence related to adverse events following bystander naloxone administration. Methods The research team used descriptive statistics from Take-Home Naloxone administration forms. We explored reported demographic variables and adverse events among people who received by-stander administered naloxone in a suspected opioid overdose event between August 31, 2012 and December 31, 2018 in British Columbia. We examined and contextualized differences across years given policy, program and drug toxicity changes. We used multivariate logistic regression to examine whether an association exists between number of ampoules of naloxone administered and the odds that the recipient will experience withdrawal symptoms. Results A large majority (98.1%) of individuals who were administered naloxone survived their overdose and 69.2% had no or only mild withdrawal symptoms. Receiving three (Adjusted Odds Ratio (AOR) 1.64 (95% Confidence Interval (CI): 1.08–2.48)) or four or more (AOR 2.19 (95% CI: 1.32–3.62)) ampoules of naloxone was significantly associated with odds of moderate or severe withdrawal compared to receiving one ampoule of naloxone. Conclusions This study provides evidence from thousands of bystander reversed opioid overdoses using Take-Home Naloxone kits in British Columbia, and suggests bystander-administered naloxone is safe and effective for opioid overdose reversal. Data suggests an emphasis on titration during bystander naloxone training in situations where the person experiencing overdose can be adequately ventilated may help avoid severe withdrawal symptoms. We identified a decreasing trend in the likelihood of moderate or severe withdrawal over the study period.

scholarly journals Take-Home Naloxone Programs for Suspected Opioid Overdose in Community Settings: A Scoping Umbrella Review

2021 ◽  
Author(s):  
Amina Moustaqim-Barrette ◽  
Damon Dhillon ◽  
Justin Ng ◽  
Kristen Sundvick ◽  
Farihah Ali ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Adverse Events ◽  
Systematic Reviews ◽  
Grey Literature ◽  
Opioid Overdose ◽  
Naloxone Administration ◽  
Routes Of Administration ◽  
Rapid Reviews ◽  
Scoping Reviews ◽  
Overdose Deaths

Abstract Background: Opioid related overdoses and overdose deaths continue to constitute an urgent public health crisis. The implementation of naloxone programs, such as ‘take-home naloxone’ (THN), has emerged as a key intervention in reducing opioid overdose deaths. These programs aim to train individuals at risk of witnessing or experiencing an opioid overdose to recognize an opioid overdose and respond with naloxone. Naloxone effectively reverses opioid overdoses on a biological level; however, there are outstanding questions on community THN program effectiveness (adverse events, dosing requirements, dose-response between routes of administration) and implementation (accessibility, availability, and affordability). The objective of this scoping review is to identify existing systematic reviews and best practice guidelines relevant to clinical and operational guidance on the distribution of THN.Methods: Using the Arksey & O’Malley framework for scoping reviews, we searched both academic literature and grey literature databases using keywords (Naloxone) AND (Overdose) AND (Guideline OR Review OR Recommendation OR Toolkit). Only documents which had a structured review of evidence and/or provided summaries or recommendations based on evidence were included (systematic reviews, meta-analyses, scoping reviews, short-cut or rapid reviews, practice/clinical guidelines, and reports). Data were extracted from selected evidence in two key areas: (1) study identifiers; and (2) methodological characteristics. Results: A total of 47 articles met inclusion criteria: 20 systematic review; 10 grey literature articles; 8 short-cut or rapid reviews; 4 scoping reviews; and 5 other review types (e.g. mapping review and comprehensive reviews). The most common subject themes were: naloxone effectiveness, safety, provision feasibility/acceptability of naloxone distribution, dosing and routes of administration, overdose response after naloxone administration, cost-effectiveness, naloxone training and education, and recommendations for policy, practice and gaps in knowledge. Conclusions: Several recent systematic reviews address the effectiveness of take-home naloxone programs, naloxone dosing/route of administration, and naloxone provision models. Gaps remain in the evidence around evaluating cost-effectiveness, training parameters and strategies, and adverse events following naloxone administration. As THN programs continue to expand in response to opioid overdose deaths, this review will contribute to understanding the evidence 60 base for policy and THN program development and expansion.

scholarly journals Take-home naloxone programs for suspected opioid overdose in community settings: a scoping umbrella review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amina Moustaqim-Barrette ◽  
Damon Dhillon ◽  
Justin Ng ◽  
Kristen Sundvick ◽  
Farihah Ali ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Adverse Events ◽  
Systematic Reviews ◽  
Grey Literature ◽  
Opioid Overdose ◽  
Naloxone Administration ◽  
Routes Of Administration ◽  
Rapid Reviews ◽  
Scoping Reviews ◽  
Overdose Deaths

Abstract Background Opioid related overdoses and overdose deaths continue to constitute an urgent public health crisis. The implementation of naloxone programs, such as ‘take-home naloxone’ (THN), has emerged as a key intervention in reducing opioid overdose deaths. These programs aim to train individuals at risk of witnessing or experiencing an opioid overdose to recognize an opioid overdose and respond with naloxone. Naloxone effectively reverses opioid overdoses on a physiological level; however, there are outstanding questions on community THN program effectiveness (adverse events, dosing requirements, dose-response between routes of administration) and implementation (accessibility, availability, and affordability). The objective of this scoping review is to identify existing systematic reviews and best practice guidelines relevant to clinical and operational guidance on the distribution of THN. Methods Using the Arksey & O’Malley framework for scoping reviews, we searched both academic literature and grey literature databases using keywords (Naloxone) AND (Overdose) AND (Guideline OR Review OR Recommendation OR Toolkit). Only documents which had a structured review of evidence and/or provided summaries or recommendations based on evidence were included (systematic reviews, meta-analyses, scoping reviews, short-cut or rapid reviews, practice/clinical guidelines, and reports). Data were extracted from selected evidence in two key areas: (1) study identifiers; and (2) methodological characteristics. Results A total of 47 articles met inclusion criteria: 20 systematic reviews; 10 grey literature articles; 8 short-cut or rapid reviews; 4 scoping reviews; and 5 other review types (e.g. mapping review and comprehensive reviews). The most common subject themes were: naloxone effectiveness, safety, provision feasibility/acceptability of naloxone distribution, dosing and routes of administration, overdose response after naloxone administration, cost-effectiveness, naloxone training and education, and recommendations for policy, practice and gaps in knowledge. Conclusions Several recent systematic reviews address the effectiveness of take-home naloxone programs, naloxone dosing/route of administration, and naloxone provision models. Gaps remain in the evidence around evaluating cost-effectiveness, training parameters and strategies, and adverse events following naloxone administration. As THN programs continue to expand in response to opioid overdose deaths, this review will contribute to understanding the evidence base for policy and THN program development and expansion.

Intranasal naloxone administration by police first responders is associated with decreased opioid overdose deaths

2015 ◽  
Vol 33 (9) ◽  
pp. 1201-1204 ◽  
Author(s):  
Jessica Rando ◽  
Derek Broering ◽  
James E. Olson ◽  
Catherine Marco ◽  
Stephen B. Evans
Keyword(s):  
First Responders ◽  
Opioid Overdose ◽  
Naloxone Administration ◽  
Overdose Deaths

Lofexidine: A Novel Treatment Option for Opioid Withdrawal Symptoms

2020 ◽  
Vol 35 (10) ◽  
pp. 413-418
Author(s):  
Olga Hilas ◽  
Tina Caliendo
Keyword(s):  
Prescription Drugs ◽  
Treatment Plan ◽  
The United States ◽  
Opioid Withdrawal ◽  
Withdrawal Symptoms ◽  
Opioid Overdose ◽  
Health Issues ◽  
Emerging Therapies ◽  
Opioid Medications ◽  
Overdose Deaths

Substance misuse in adults 60 years of age and older is one of the fastest-growing health issues in the United States. Alcohol and prescription drugs are among the most commonly misused agents. With growing concern for opioid-overdose deaths and the use of opioids in the treatment of persistent pain in older adults, it is imperative that practitioners are aware of emerging therapies used to manage the symptoms that may result after discontinuation of opioid medications. This review highlights the first nonopioid treatment plan for the management of opioid withdrawal symptoms with a novel pharmacologic mechanism.

scholarly journals Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e025567
Author(s):  
Richard L Morrow ◽  
Ken Bassett ◽  
Malcolm Maclure ◽  
Colin R Dormuth
Keyword(s):  
British Columbia ◽  
Cohort Study ◽  
Adverse Events ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Secondary Analysis ◽  
Secondary Outcome ◽  
Opioid Overdose ◽  
Composite Outcome ◽  
Serious Adverse Events

ObjectivesTo study the association between accidental opioid overdose and neurological, respiratory, cardiac and other serious adverse events and whether risk of these adverse events was elevated during hospital readmissions compared with initial admissions.DesignRetrospective cohort study.SettingPopulation-based study using linked administrative data in British Columbia, Canada.ParticipantsThe primary analysis included 2433 patients with 2554 admissions for accidental opioid overdose between 2006 and 2015, including 121 readmissions within 1 year of initial admission. The secondary analysis included 538 patients discharged following a total of 552 accidental opioid overdose hospitalizations and 11 040 matched controls from a cohort of patients with ≥180 days of prescription opioid use.Outcome measuresThe primary outcome was encephalopathy; secondary outcomes were adult respiratory distress syndrome, respiratory failure, pulmonary haemorrhage, aspiration pneumonia, cardiac arrest, ventricular arrhythmia, heart failure, rhabdomyolysis, paraplegia or tetraplegia, acute renal failure, death, a composite outcome of encephalopathy or any secondary outcome and total serious adverse events (all-cause hospitalisation or death). We analysed these outcomes using generalised linear models with a logistic link function.Results3% of accidental opioid overdose admissions included encephalopathy and 25% included one or more adverse events (composite outcome). We found no evidence of increased risk of encephalopathy (OR 0.57; 95% CI 0.13 to 2.49) or other outcomes during readmissions versus initial admissions. In the secondary analysis, <5 patients in each cohort experienced encephalopathy. Risk of the composite outcome (OR 2.15; 95% CI 1.48 to 3.12) and all-cause mortality (OR 2.13; 95% CI 1.18 to 3.86) were higher for patients in the year following overdose relative to controls.ConclusionsWe found no evidence that risk of encephalopathy or other adverse events was higher in readmissions compared with initial admissions for accidental opioid overdose. Risk of serious morbidity and mortality may be elevated in the year following an accidental opioid overdose.

02 Leveraging paramedic data to investigate the effect of COVID-19 on community opioid overdoses

2021 ◽  
Vol 38 (9) ◽  
pp. A1.2-A2
Author(s):  
J Chris Smith ◽  
Wesley Burr
Keyword(s):  
Harm Reduction ◽  
Goodness Of Fit ◽  
P Value ◽  
Opioid Overdose ◽  
Naloxone Administration ◽  
Data Ethics ◽  
Community Monitoring ◽  
Chi Squared ◽  
Containment Measures ◽  
Bystander Naloxone

BackgroundOpioid overdoses in Canada have shown dramatic increases over recent years, despite significant investments in harm reduction. Most community monitoring currently relies on emergency department and coroner data. Our team has previously shown that paramedic data can be a useful addition to the current metrics as paramedics regularly interact with opioid overdose patients. This study examines paramedic data to investigate the changes to community opioid overdoses in the era of COVID-19 to better support our strategic partners in their battle against the opioid crisis.MethodsThe electronic ambulance call report database of Peterborough Paramedics (Ontario, Canada) was examined. De-identified records for patients from 2017-2020 with documented problem codes of ‘Opioid Overdose’ were extracted. Patients receiving paramedic naloxone were also included. The data was cleaned and analysed, and incomplete records were removed. Statistical models including chi-squared tests of goodness-of-fit and post hoc pairwise t-tests were applied to the data. Ethics approval for this study was granted by the Trent University’s Research Ethics Board.Results788 opioid overdoses were identified out of 72,737 patients. There were 263 opioid overdoses found in 2020 representing 1.4% patients, a significant increase from 2017-2019 (p value: 0.006). The proportion of patients receiving paramedic naloxone was significantly increased from previous years (p value: 0.005) while bystander naloxone administration was significantly decreased (p value 0.002). Age, gender, and pick-up location types were not significantly different between 2020 and previous years.ConclusionDespite reduced overall call volumes in 2020, paramedics observed an increase in opioid overdoses. The increase in paramedic naloxone administration and decrease in bystander naloxone administration may indicate changes in usage practices of community opioid users or an instability in the drug supply. These factors must be considered in future opioid harm reduction strategies and public health COVID-19 containment measures.

Lofexidine: A Novel Treatment Option for Opioid Withdrawal Symptoms

2020 ◽  
Vol 35 (10) ◽  
pp. 413-418
Author(s):  
Olga Hilas ◽  
Tina Caliendo
Keyword(s):  
Prescription Drugs ◽  
Treatment Plan ◽  
The United States ◽  
Opioid Withdrawal ◽  
Withdrawal Symptoms ◽  
Opioid Overdose ◽  
Health Issues ◽  
Emerging Therapies ◽  
Opioid Medications ◽  
Overdose Deaths

Substance misuse in adults 60 years of age and older is one of the fastest-growing health issues in the United States. Alcohol and prescription drugs are among the most commonly misused agents. With growing concern for opioid-overdose deaths and the use of opioids in the treatment of persistent pain in older adults, it is imperative that practitioners are aware of emerging therapies used to manage the symptoms that may result after discontinuation of opioid medications. This review highlights the first nonopioid treatment plan for the management of opioid withdrawal symptoms with a novel pharmacologic mechanism.

scholarly journals Opioid Stewardship Program and Postoperative Adverse Events

2020 ◽  
Vol 132 (6) ◽  
pp. 1558-1568
Author(s):  
Antje M. Barreveld ◽  
Robert J. McCarthy ◽  
Nabil Elkassabany ◽  
Edward R. Mariano ◽  
Brian Sites ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Adverse Events ◽  
Opioid Analgesics ◽  
Educational Interventions ◽  
Multimodal Analgesia ◽  
Hospitalized Patients ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Naloxone Administration ◽  
Stewardship Program

Abstract Background A 6-month opioid use educational program consisting of webinars on pain assessment, postoperative and multimodal pain opioid management, safer opioid use, and preventing addiction coupled with on-site coaching and monthly assessments reports was implemented in 31 hospitals. The authors hypothesized the intervention would measurably reduce and/or prevent opioid-related harm among adult hospitalized patients compared to 33 nonintervention hospitals. Methods Outcomes were extracted from medical records for 12 months before and after the intervention start date. Opioid adverse events, evaluated by opioid overdose, wrong substance given or taken in error, naloxone administration, and acute postoperative respiratory failure causing prolonged ventilation were the primary outcomes. Opioid use in adult patients undergoing elective hip or knee arthroplasty or colorectal procedures was also assessed. Differences-in-differences were compared between intervention and nonintervention hospitals. Results Before the intervention, the incidence ± SD of opioid overdose, wrong substance given, or substance taken in error was 1 ± 0.5 per 10,000 discharges, and naloxone use was 117 ± 13 per 10,000 patients receiving opioids. The incidence of respiratory failure was 42 ± 10 per 10,000 surgical discharges. A difference-in-differences of –0.2 (99% CI, –1.1 to 0.6, P = 0.499) per 10,000 in opioid overdose, wrong substance given, or substance taken in error and –13.6 (99% CI, –29.0 to 0.0, P = 0.028) per 10,000 in respiratory failure was observed postintervention in the intervention hospitals; however, naloxone administration increased by 15.2 (99% CI, 3.8 to 30.0, P = 0.011) per 10,000. Average total daily opioid use, as well as the fraction of patients receiving daily opioid greater than 90 mg morphine equivalents was not different between the intervention and nonintervention hospitals. Conclusions A 6-month opioid educational intervention did not reduce opioid adverse events or alter opioid use in hospitalized patients. The authors’ findings suggest that despite opioid and multimodal analgesia awareness, limited-duration educational interventions do not substantially change the hospital use of opioid analgesics. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

A Thematic Analysis of Overdose Prevention and Response Efforts in States Experiencing Declines in Rates of Opioid-Involved Overdose Deaths

2021 ◽  
pp. 003335492110268
Author(s):  
Amber B. Robinson ◽  
Nida Ali ◽  
Olga Costa ◽  
Cherie Rooks-Peck ◽  
Amy Sorensen-Alawad ◽  
...  
Keyword(s):  
Thematic Analysis ◽  
Prevention Program ◽  
Data Access ◽  
Mortality Rates ◽  
Opioid Overdose ◽  
Overdose Prevention ◽  
Core Elements ◽  
Specific Activities ◽  
Context Specific ◽  
Overdose Deaths

Objective To address the opioid overdose epidemic, it is important to understand the broad scope of efforts under way in states, particularly states in which the rate of opioid-involved overdose deaths is declining. The primary objective of this study was to examine core elements of overdose prevention activities in 4 states with a high rate of opioid-involved overdose deaths that experienced a decrease in opioid-involved overdose deaths from 2016 to 2017. Methods We identified 5 states experiencing decreases in age-adjusted mortality rates for opioid-involved overdoses from 2016 to 2017 and examined their overdose prevention programs via program narratives developed with collaborators from each state’s overdose prevention program. These program narratives used 10 predetermined categories to organize activities: legislative policies; strategic planning; data access, capacity, and dissemination; capacity building; public-facing resources (eg, web-based dashboards); training resources; enhancements and improvements to prescription drug monitoring programs; linkage to care; treatment; and community-focused initiatives. Using qualitative thematic analysis techniques, core elements and context-specific activities emerged. Results In the predetermined categories of programmatic activities, we identified the following core elements of overdose prevention and response: comprehensive state policies; strategic planning; local engagement; data access, capacity, and dissemination; training of professional audiences (eg, prescribers); treatment infrastructure; and harm reduction. Conclusions The identification of core elements and context-specific activities underscores the importance of implementation and adaptation of evidence-based prevention strategies, interdisciplinary partnerships, and collaborations to address opioid overdose. Further evaluation of these state programs and other overdose prevention efforts in states where mortality rates for opioid-involved overdoses declined should focus on impact, optimal timing, and combinations of program activities during the life span of an overdose prevention program.

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