Community Based Naloxone Kits

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Gillian HARVEY ◽  
Stephanie VANDENBERG
Keyword(s):  
Lived Experience ◽  
Motor Vehicle ◽  
User Behavior ◽  
Opioid Antagonist ◽  
Opioid Overdose ◽  
Community Based ◽  
Health Crisis ◽  
Opioid Crisis ◽  
Wide Availability ◽  
Pilot Work

The opioid crisis in Alberta is a public health crisis. In 2016, more people died from an opioid poisoning than from motor vehicle crashes. Naloxone is an opioid antagonist which means that it can reverse an opioid overdose for a period of 30–60 minutes, at which point, the overdose may return. In December 2015, the Take Home Naloxone (THN) Program was rolled out in response to the opioid crisis. Under the renamed the Community Based Naloxone Kit Program (CBNP), naloxone kits are now available free of cost at many pharmacies and community clinics around Alberta. The wide availability has led to a new challenge—that the kits may be used by people who have received little to no training.Some may encounter the kit instructions for the first time when there is an emergency in which they need to administer an injection urgently to someone who has passed out. Studies have found that most overdoses occur in the presence of another person—this provides an opportunity for someone to intervene. People often die from witnessed opioid poisonings because other people do not know what to do to help. A pilot study conducted through community partnerships involved 30 participants in two different urban centres (Edmonton and Calgary) who self identified as either experienced in substance use or friends/family of people with lived experience has revealed some interesting findings.Qualitative observations and data collected in the initial pilot work show that end users are experiencing unique challenges in accessing opioid education and have challenges using instructions on how to administer naloxone in an overdose setting. User testing and observation of user behavior has great potential to support educational material for opioid awareness.Human-centred design approaches that gather information with and about people using antidote kits are urgently needed in order to mitigate risk and ensure successful administration of first aid and naloxone in an emergency.

scholarly journals MP29: Community based naloxone usability testing

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S52-S53
Author(s):  
S. VandenBerg ◽  
G. Harvey ◽  
J. Martel ◽  
S. Gill ◽  
J. McLaren
Keyword(s):  
Harm Reduction ◽  
Lived Experience ◽  
Motor Vehicle ◽  
Opioid Antagonist ◽  
Opioid Overdose ◽  
Data Sampling ◽  
Art And Design ◽  
University Of Alberta ◽  
Human Centred Design ◽  
The Way

Background: In Alberta in 2016 more people died from an opioid overdose than from motor vehicle crashes. Naloxone is an opioid antagonist - it can reverse an opioid overdose for a period of 30 to 60 minutes. Naloxone kits are available free at emergency departments and community organizations around the province with training provided at the point of pickup. It is possible that training may be refused or may be forgotten and people are often left to rely solely on the instructions included in the kit. Human centred design can improve the way people interact with overdose instructions. Aim Statement: This study will measure the effectiveness and usefulness of prototype community naloxone kit instructions over a six month period of time (2018) in Calgary and Edmonton with the aim to use human centred design principles to improve the way people interpret emergency overdose response directions. Measures & Design: Information design experts engaged people with lived experience to provide a process map outlining the current role that educational materials and instructions for community naloxone kits play in responding to an opioid overdose. Alberta Health Services (AHS) Human Factors, in collaboration with AHS harm reduction developed the protocol and administered pre- and post-questionnaire and specific ‘performance checkpoints’ intended to measure effectiveness and usefulness. A simulated overdose including a mannequin, injection trainer and anatomical paper diagram was designed and a community naloxone kit with instructions setting was provided. Participants were recruited through harm reduction nurses with pre-existing clinical relationships (experienced group), family and friends of people who use opioids and general public (non-experienced) through the University of Alberta Faculty of Art and Design. Evaluation/Results: A total of 30 voluntary participants provided their informed consent and engaged in a simulated overdose scenario using a set of prototype instructions developed by a professional information designer. Through repeated data sampling, the following points were observed and will be integrated in the next iteration of design: It isn't clear to people what opioids are. It isn't clear to people that giving a dose of naloxone will not harm a person, especially if they have not overdosed. Almost none of the participants called 911. People seem to read pictures and text equally in the non-experienced group, but in the experienced group, typically read the pictures. Many participants stated that they knew how to do rescue breaths, but did not perform them correctly. Performing the procedure is a not the same as being asked about how to perform the procedure. Discussion/Impact: Even with new instructional prototypes, many participants identified components that were unclear or confusing. The experienced group made less mistakes than the non-experienced group. They seemed to be more invested or interested in saving a friend's life. These instructions will go through another round of design to incorporate feedback from end users. The final product will be part of a larger provincial emergency medicine initiative that includes participant led design and education around emergency response in opioid overdose settings.

scholarly journals Incidence of mortality due to rebound toxicity after ‘treat and release’ practices in prehospital opioid overdose care: a systematic review

2018 ◽  
Vol 36 (4) ◽  
pp. 219-224 ◽  
Author(s):  
Jennifer Anne Greene ◽  
Brent J Deveau ◽  
Justine S Dol ◽  
Michael B Butler
Keyword(s):  
Adverse Events ◽  
Ventilatory Support ◽  
Risk Of Bias ◽  
Opioid Antagonist ◽  
Opioid Overdose ◽  
Serious Adverse Events ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Overdose Mortality ◽  
Do So

IntroductionDeath due to opioid overdose was declared a public health crisis in Canada in 2015. Traditionally, patients who have overdosed on opioids that are managed by emergency medical services (EMS) are treated with the opioid antagonist naloxone, provided ventilatory support and subsequently transported to hospital. However, certain EMS agencies have permitted patients who have been reversed from opioid overdose to refuse transport, if the patient exhibits capacity to do so. Evidence on the safety of this practice is limited. Therefore, our intent was to examine the available literature to determine mortality and serious adverse events within 48 hours of EMS treat and release due to suspected rebound opioid toxicity after naloxone administration.MethodsA systematic search was performed on 11 May 2017 in PubMed, Cochrane Central, Embase and CINHAL. Studies that reported on the outcome of patients treated with prehospital naloxone and released at the scene were included. Analyses for incidence of mortality and adverse events at the scene were conducted. Risk of bias and assessment of publication bias was also done.Results1401 records were screened after duplicate removal. Eighteen full-text studies were reviewed with seven selected for inclusion. None were found to be high risk of bias. In most studies, heroin was the source of the overdose. Mortality within 48 hours was infrequent with only four deaths among 4912 patients ﴾0.081%﴿ in the seven studies. Only one study reported on adverse events and found no incidence of adverse events from their sample of 71 released patients.ConclusionMortality or serious adverse events due to suspected rebound toxicity in patients released on scene post-EMS treatment with naloxone were rare. However, studies involving longer-acting opioids were rare and no study involved fentanyl.

Changing Law from Barrier to Facilitator of Opioid Overdose Prevention

2013 ◽  
Vol 41 (S1) ◽  
pp. 33-36 ◽  
Author(s):  
Corey Davis ◽  
Damika Webb ◽  
Scott Burris
Keyword(s):  
Motor Vehicle ◽  
Unintentional Injury ◽  
The United States ◽  
Opioid Antagonist ◽  
Opioid Overdose ◽  
Injury Death ◽  
Overdose Prevention ◽  
Vehicle Accidents ◽  
The Brain ◽  
Hispanic White

Drug overdose has recently surpassed motor vehicle accidents to become the leading cause of unintentional injury death in the United States. The epidemic is largely driven by opioids such as oxycodone, hydrocodone, and methadone, which kill more Americans than heroin and cocaine combined. The demographics of overdose have changed over the past few decades as well: according to the latest data, the average overdose victim is now a non-Hispanic white man aged 45-54.These deaths — over 16,000 per year — are almost entirely preventable. Opioid overdose kills by slowly depressing respiration, a process that can take several hours. It can be quickly and effectively reversed by the timely administration of naloxone, an opioid antagonist that works by displacing opioids from the brain receptors to which they attach, reversing their depressant effect. Naloxone, also known as Narcan, has many benefits and minimal risks. Although it is a prescription drug, it is not a controlled substance and has no abuse potential.

scholarly journals 3570 The Regulatory Landscape of Products to Treat Opioid Overdose

2019 ◽  
Vol 3 (s1) ◽  
pp. 58-59
Author(s):  
Pooja Singh ◽  
Kaylene Okada ◽  
Amelia Spinrad ◽  
Nancy Pire-Smerkanich ◽  
Eunjoo Pacifici
Keyword(s):  
United States ◽  
Phase I ◽  
Nasal Spray ◽  
The United States ◽  
Regulatory Framework ◽  
Opioid Antagonist ◽  
Opioid Overdose ◽  
Opioid Crisis ◽  
Pubmed Search ◽  
Auto Injector

OBJECTIVES/SPECIFIC AIMS: Since 1971, Naloxone has been the only FDA approved opioid antagonist indicated for use after opioid overdose. New formulations of Naloxone have been introduced into the market, including an injectable, auto-injector, and nasal spray. However, Naloxone is short-acting and as such often requires multiple doses and may induce severe withdrawal symptoms. This study examines the regulatory framework to understand the evolution of products indicated to treat opioid overdose and the landscape of therapies in development. Furthermore, this study examines how the Food and Drug Administration (FDA) and other government agencies have approached the opioid crisis. METHODS/STUDY POPULATION: A PubMed search of “naloxone AND opioid overdose” with the filter “humans” was conducted to understand Naloxone’s regulatory framework. The term “naloxone” was searched on the Drugs@FDA: Approved Drug Products database. Additionally, “nalmefene” was searched on ClinicalTrials.gov. To examine the opioid antagonist market landscape, a PubMed search of “opioid antagonist AND opioid overdose” with the filters “humans” and “clinical trial,” and a ClinicalTrials.gov search of “opioid antagonist and opioid overdose,” were conducted. Government agency reports were reviewed and cataloged. RESULTS/ANTICIPATED RESULTS: Preliminary findings suggest a lack of innovation in the development of novel opioid antagonists. Most literature review findings focused on already-marketed Naloxone products, including the original injectable approved in 1971, the 2014 Evzio Auto-Injector, and the 2015 Narcan Nasal Spray (Figure 1). For example, there were 14 results yielded from the FDA approvals database, but none of these results represented a new opioid antagonist molecule. A longer-acting opioid antagonist, Nalmefene injectable, was approved in 1995 but has since been removed from the market due to low sales. Our initial ClinicalTrials.gov search using condition “opioid overdose” and other terms “opioid antagonist”,revealed no new studies being conducted on alternative opioid antagonist treatments for opioid overdose. Findings only focused on the distribution, co-dispensing, intervention, pharmacokinetics/pharmacodynamics (PK/PD) of Naloxone (Figure 2). However, a Google search yielded one new trial with an opioid antagonist by Opiant Pharmaceuticals, almost fifty years after FDA’s approval of Naloxone. A ClinicalTrials.gov search was then performed using the search term “nalmefene” to find whether Opiant Pharmaceuticals’ trial was in the ClinicalTrials.gov database. However, the Opiant trial is phase I, and as such does not require reporting on ClinicalTrials.gov. In 2017, the National Institutes of Health (NIH) launched an initiative for longer-acting opioid antagonist formulations. In 2018, Opiant Pharmaceuticals announced positive phase I results for intranasal Nalmefene. The potential return of Nalmefene in intranasal form may play a significant role in reducing overdoses, especially in cases where a longer-acting opioid antagonist is necessary. Opiant Pharmaceuticals’ trial commenced after the NIH announced their initiative; furthermore, the NIH’s National Institute on Drug Abuse granted the company $7.4 million to further the investigation of this drug. We will continue to research drugs that have previously been studied for the indication of treating opioid overdose in the United States and abroad and catalog them. DISCUSSION/SIGNIFICANCE OF IMPACT: The abuse and misuse of opioids in the United States has caused an epidemic accounting for over 115 opioid-overdose deaths each day, devastating our nation, both socially and economically. The United States spends $78.5 billion annually to combat the misuse of these drugs. Due to the severity of the opioid crisis, efforts to better understand approved therapies and investigational products in development to treat opioid overdose will be of significance moving forward. This research can inform agencies who are developing strategies to reduce opioid overdoses and pharmaceutical product developers about the current opioid antagonist landscape.

From Urban Renewal to the BeltLine: Atlanta’s Use of Public Health Narratives to Reshape the City

2021 ◽  
pp. 153851322098415
Author(s):  
L. Katie OConnell ◽  
Nisha Botchwey
Keyword(s):  
Public Health ◽  
Lived Experience ◽  
Urban Renewal ◽  
Black Communities ◽  
Health Crisis ◽  
Planning Profession ◽  
White Middle Class ◽  
Mass Displacement ◽  
City Agencies ◽  
The City

Since the early days of the planning profession, city agencies relied on a public health crisis narrative as a rationale for mass displacement efforts that targeted black communities. Over time, as cities gentrified with white, middle-class residents, the narrative shifted toward the city as a place of health. This article compares Atlanta’s redevelopment narratives from urban renewal to its current citywide greenway project, the BeltLine, to understand how city officials utilized public health language to rationalize displacement and how the narratives ran counter to residents’ lived experience.

scholarly journals Civil society involvement in harm reduction drug policy: reflections on the past, expectations for the future

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Aileen O’Gorman ◽  
Eberhard Schatz
Keyword(s):  
Civil Society ◽  
Harm Reduction ◽  
Lived Experience ◽  
Political Institutions ◽  
Drug Policy ◽  
Policy Development ◽  
Policy Decision ◽  
People Who Use Drugs ◽  
Annual Conference ◽  
Health Crisis

Abstract Background A range of civil society organisations (CSOs) such as drug user groups, non-governmental/third sector organisations and networks of existing organisations, seek to shape the development of drugs policy at national and international levels. However, their capacity to do so is shaped by the contexts in which they operate nationally and internationally. The aim of this paper is to explore the lived experience of civil society participation in these contexts, both from the perspective of CSOs engaged in harm reduction advocacy, and the institutions they engage with, in order to inform future policy development. Methods This paper is based on the presentations and discussions from a workshop on ‘Civil Society Involvement in Drug Policy hosted by the Correlation - European Harm Reduction Network at the International Society for the Study of Drugs Policy (ISSDP) annual conference in Paris, 2019. In the aftermath of the workshop, the authors analysed the papers and discussions and identified the key themes arising to inform CSI in developing future harm reduction policy and practice. Results Civil society involvement (CSI) in policy decision-making and implementation is acknowledged as an important benefit to representative democracy. Yet, the accounts of CSOs demonstrate the challenges they experience in seeking to shape the contested field of drug policy. Negotiating the complex workings of political institutions, often in adversarial and heavily bureaucratic environments, proved difficult. Nonetheless, an increase in structures which formalised and resourced CSI enabled more meaningful participation at different levels and at different stages of policy making. Conclusions Civil society spaces are colonised by a broad range of civil society actors lobbying from different ideological standpoints including those advocating for a ‘drug free world’ and those advocating for harm reduction. In these competitive arena, it may be difficult for harm reduction orientated CSOs to influence the policy process. However, the current COVID-19 public health crisis clearly demonstrates the benefits of partnership between CSOs and political institutions to address the harm reduction needs of people who use drugs. The lessons drawn from our workshop serve to inform all partners on this pathway.

scholarly journals Designing a Graphic Novel: Engaging Community, Arts, and Culture Into Public Health Initiatives

2021 ◽  
Vol 22 (1_suppl) ◽  
pp. 35S-43S
Author(s):  
Sarah Febres-Cordero ◽  
Athena D. F. Sherman ◽  
Joseph Karg ◽  
Ursula Kelly ◽  
Lisa M. Thompson ◽  
...  
Keyword(s):  
Public Health ◽  
Service Industry ◽  
Community Setting ◽  
Graphic Novel ◽  
Community Advisory Board ◽  
Opioid Antagonist ◽  
Dissemination And Implementation ◽  
Opioid Overdose ◽  
Negative Stereotypes ◽  
Community Based Research

The opioid epidemic was declared a national public health emergency in 2017. In Georgia, standing orders for the opioid antagonist, naloxone, have been implemented to reduce mortality from opioid overdoses. Service industry workers in the Atlanta, Georgia, inner-city community of Little Five Points (L5P) have access to naloxone, potentially expanding overdose rescue efforts in the community setting. To explore the issues facing L5P, our research brings together qualitative descriptive inquiry, ethnography, community-based research, a community advisory board, and a local artist to maximize community dissemination of research findings through a graphic novel that describes encountering an opioid overdose. This format was chosen due to the ethical responsibility to disseminate in participants’ language and for its potential to empower and educate readers. This article describes the process of working on this study with the community and a local artist to create sample pages that will be tested for clarity of the message in a later phase. Working with an artist has revealed that while dissemination and implementation for collaboration begin before findings are ready, cross-collaboration with the artist requires early engagement, substantial funding, artist education in appropriate content, and member checking to establish community acceptability altering illustrations that reinforce negative stereotypes. By sharing the experiences of actions taken during an opioid overdose in L5P through a graphic novel, we can validate service industry workers’ experiences, acknowledge their efforts to contribute to harm reduction, and provide much-needed closure to those who encounter opioid overdoses in the community.

scholarly journals Emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs in Canadian emergency departments

CJEM ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Lauren Lacroix ◽  
Lisa Thurgur ◽  
Aaron M. Orkin ◽  
Jeffrey J. Perry ◽  
Ian G. Stiell
Keyword(s):  
At Risk ◽  
Perceived Barriers ◽  
Face Validity ◽  
Opioid Overdose ◽  
Emergency Physicians ◽  
Web Based ◽  
Health Crisis ◽  
Canadian Association ◽  
National Public Health

AbstractObjectivesRates of opioid-related deaths have reached the level of national public health crisis in Canada. Community-based opioid overdose education and naloxone distribution (OEND) programs distribute naloxone to people at risk, and the emergency department (ED) may be an underutilized setting to deliver naloxone to these people. The goal of this study was to identify Canadian emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs.MethodsThis was an anonymous Web-based survey of members of the Canadian Association of Emergency Physicians. Survey questions were developed by the research team and piloted for face validity and clarity. Two reminder emails were sent to non-responders at 2-week intervals. Respondent demographics were collected, and Likert scales were used to assess attitudes and barriers to the prescription of naloxone from the ED.ResultsA total of 459 physicians responded. The majority of respondents were male (64%), worked in urban tertiary centres (58.3%), and lived in Ontario (50.6%). Overall, attitudes to OEND were strongly positive; 86% identified a willingness to prescribe naloxone from the ED. Perceived barriers included support for patient education (57%), access to follow-up (44%), and inadequate time (37%). In addition to people at risk of overdose, 77% of respondents identified that friends and family members may also benefit.ConclusionsCanadian emergency physicians are willing to distribute take-home naloxone, but thoughtful systems are required to facilitate opioid OEND implementation. These data will inform the development of these programs, with emphasis on multidisciplinary training and education.

scholarly journals Concerns Expressed by Chinese Social Media Users During the COVID-19 Pandemic: Content Analysis of Sina Weibo Microblogging Data (Preprint)

2020 ◽  
Author(s):  
Junze Wang ◽  
Ying Zhou ◽  
Wei Zhang ◽  
Richard Evans ◽  
Chengyan Zhu
Keyword(s):  
Social Media ◽  
Latent Dirichlet Allocation ◽  
Vaccine Development ◽  
User Behavior ◽  
Chinese Government ◽  
Web Crawler ◽  
Health Crisis ◽  
User Behavior Analysis ◽  
Sina Weibo ◽  
Social Media Platforms

BACKGROUND The COVID-19 pandemic has created a global health crisis that is affecting economies and societies worldwide. During times of uncertainty and unexpected change, people have turned to social media platforms as communication tools and primary information sources. Platforms such as Twitter and Sina Weibo have allowed communities to share discussion and emotional support; they also play important roles for individuals, governments, and organizations in exchanging information and expressing opinions. However, research that studies the main concerns expressed by social media users during the pandemic is limited. OBJECTIVE The aim of this study was to examine the main concerns raised and discussed by citizens on Sina Weibo, the largest social media platform in China, during the COVID-19 pandemic. METHODS We used a web crawler tool and a set of predefined search terms (<i>New Coronavirus Pneumonia</i>, <i>New Coronavirus</i>, and <i>COVID-19</i>) to investigate concerns raised by Sina Weibo users. Textual information and metadata (number of likes, comments, retweets, publishing time, and publishing location) of microblog posts published between December 1, 2019, and July 32, 2020, were collected. After segmenting the words of the collected text, we used a topic modeling technique, latent Dirichlet allocation (LDA), to identify the most common topics posted by users. We analyzed the emotional tendencies of the topics, calculated the proportional distribution of the topics, performed user behavior analysis on the topics using data collected from the number of likes, comments, and retweets, and studied the changes in user concerns and differences in participation between citizens living in different regions of mainland China. RESULTS Based on the 203,191 eligible microblog posts collected, we identified 17 topics and grouped them into 8 themes. These topics were pandemic statistics, domestic epidemic, epidemics in other countries worldwide, COVID-19 treatments, medical resources, economic shock, quarantine and investigation, patients’ outcry for help, work and production resumption, psychological influence, joint prevention and control, material donation, epidemics in neighboring countries, vaccine development, fueling and saluting antiepidemic action, detection, and study resumption. The mean sentiment was positive for 11 topics and negative for 6 topics. The topic with the highest mean of retweets was domestic epidemic, while the topic with the highest mean of likes was quarantine and investigation. CONCLUSIONS Concerns expressed by social media users are highly correlated with the evolution of the global pandemic. During the COVID-19 pandemic, social media has provided a platform for Chinese government departments and organizations to better understand public concerns and demands. Similarly, social media has provided channels to disseminate information about epidemic prevention and has influenced public attitudes and behaviors. Government departments, especially those related to health, can create appropriate policies in a timely manner through monitoring social media platforms to guide public opinion and behavior during epidemics.

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