scholarly journals Opiate addiction and overdose: experiences, attitudes, and appetite for community naloxone provision

2017 ◽  
Vol 67 (657) ◽  
pp. e267-e273 ◽  
Author(s):  
Tomás Barry ◽  
Jan Klimas ◽  
Helen Tobin ◽  
Mairead Egan ◽  
Gerard Bury
Keyword(s):  
Multiple Dose ◽  
Healthcare Services ◽  
Postal Survey ◽  
Opiate Addiction ◽  
Overdose Prevention ◽  
Opiate Use ◽  
Urban Rural ◽  
Survey Results ◽  
Overdose Deaths ◽  
Opiate Agonist

BackgroundMore than 200 opiate overdose deaths occur annually in Ireland. Overdose prevention and management, including naloxone prescription, should be a priority for healthcare services. Naloxone is an effective overdose treatment and is now being considered for wider lay use.Aim To establish GPs’ views and experiences of opiate addiction, overdose care, and naloxone provision.Design and setting An anonymous postal survey to GPs affiliated with the Department of Academic General Practice, University College Dublin, Ireland.MethodA total of 714 GPs were invited to complete an anonymous postal survey. Results were compared with a parallel GP trainee survey.ResultsA total of 448/714 (62.7%) GPs responded. Approximately one-third of GPs were based in urban, rural, and mixed areas. Over 75% of GPs who responded had patients who used illicit opiates, and 25% prescribed methadone. Two-thirds of GPs were in favour of increased naloxone availability in the community; almost one-third would take part in such a scheme. A higher proportion of GP trainees had used naloxone to treat opiate overdose than qualified GPs. In addition, a higher proportion of GP trainees were willing to be involved in naloxone distribution than qualified GPs. Intranasal naloxone was much preferred to single (P<0.001) or multiple dose (P<0.001) intramuscular naloxone. Few GPs objected to wider naloxone availability, with 66.1% (n = 292) being in favour.ConclusionGPs report extensive contact with people who have opiate use disorders but provide limited opiate agonist treatment. They support wider availability of naloxone and would participate in its expansion. Development and evaluation of an implementation strategy to support GP-based distribution is urgently needed.

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.

Preparing pharmacists to increase naloxone dispensing within community pharmacies under the Pennsylvania standing order

2020 ◽  
Author(s):  
Heather M Santa ◽  
Samira G Amirova ◽  
Daniel J Ventricelli ◽  
George E Downs ◽  
Alexandra A Nowalk ◽  
...  
Keyword(s):  
Community Pharmacists ◽  
The United States ◽  
Health Concern ◽  
Community Pharmacies ◽  
Opioid Overdose ◽  
Patient Counseling ◽  
Opioid Use ◽  
Overdose Prevention ◽  
Standing Order ◽  
Overdose Deaths

Abstract Purpose Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County’s being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. Methods To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site–specific naloxone dispensing protocols. Results Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists’ understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists’ self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation. Conclusion Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists’ knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.

How the 2017 same-sex marriage postal survey and the 2017 Queensland state election underscore the ‘two Queenslands’ thesis

2018 ◽  
Vol 25 (1) ◽  
pp. 39-49
Author(s):  
Niels Kraaier
Keyword(s):  
Postal Survey ◽  
The State ◽  
Same Sex ◽  
The South ◽  
Same Sex Marriage ◽  
Cultural Form ◽  
Survey Results ◽  
Over Time

AbstractBased on an analysis of the 2017 same-sex marriage postal survey results and the results of the 2017 Queensland state election, this paper observes that residents of the south-east corner of the state appear to adopt feminine values as opposed to the masculinity for which Queensland is known. The results underscore the ‘two Queenslands’ thesis, which posits that the single geographic state of Queensland has cleaved over time into two entities quite distinct in their economic, political, social and cultural form. Moreover, they add fuel to the debate about secession. As residents of the south-east continue to develop their own identity, the desire for a state of South-East Queensland could at some point become a realistic scenario.

scholarly journals Naloxone Buyers Club: Overlooked Critical Public Health Infrastructure for Preventing Overdose Deaths

2021 ◽  
Author(s):  
Maya Doe-Simkins ◽  
Eliza Jane Wheeler ◽  
Mary C. Figgatt ◽  
T. Stephen Jones ◽  
Alice Bell ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Low Cost ◽  
People Who Use Drugs ◽  
Critical Element ◽  
Mutual Aid ◽  
Overdose Prevention ◽  
Service Programs ◽  
Compliance Officers ◽  
Critical Public Health ◽  
Overdose Deaths

Background Community-based naloxone distribution is an evidence-based pillar of overdose prevention. Since 2012, the naloxone Buyers Club facilitated purchase of low-cost naloxone by harm reduction and syringe service programs, the primary conduits for reaching people who use drugs. This innovative purchasing and mutual aid network has not been previously described. Methods We analyzed transactional records of naloxone orders (2017-2020, n=965), a survey of current Buyers Club members (2020, n=104), and mutual aid requests (2021, n=86). Results Between 2017 and 2020, annual orders for naloxone increased 2.6-fold. 114 unique harm reduction programs from 40 states placed orders for 3,714,110 vials of 0.4 mg/mL generic naloxone through the Buyers Club. States with most orders were: Arizona (600,000 vials), Illinois (576,800), Minnesota (347,450), California (317,200), North Carolina (315,040). Among programs that ordered naloxone in 2020, 52% (n=32) received no federal funding and ordered half as much as funded programs. During the 2021 shortage, mutual aid redistribution was common, with 80% participating as either a donor or recipient. Among 59 mutual aid requestors, 59% (n=35) were willing to accept expired naloxone; the clear preference was for generic injectable naloxone, 95% (n=56). Conclusions The naloxone Buyers Club is a critical element of overdose prevention infrastructure. Yet, barriers from corporate compliance officers and federal prescription-only status impede access. These barriers can be reduced by FDA removing the prescription requirement for naloxone and government funding for harm reduction programs.

A grazier survey of the long-term productivity of leucaena (Leucaena leucocephala)-grass pastures in Queensland

2010 ◽  
Vol 50 (2) ◽  
pp. 105 ◽  
Author(s):  
A. Radrizzani ◽  
S. A. Dalzell ◽  
O. Kravchuk ◽  
H. M. Shelton
Keyword(s):  
Leucaena Leucocephala ◽  
Management Practices ◽  
Soil Nutrient ◽  
Ground Cover ◽  
Grazing Pressure ◽  
Postal Survey ◽  
Survey Results ◽  
Livestock Productivity ◽  
Grass Growth ◽  
Changes Over Time

Leucaena leucocephala subsp. glabrata (leucaena)-grass pastures are productive, perennial and long-lived (>40 years). However, little is known about changes in the productivity of these pastures as they age even though they are grazed intensively and are rarely fertilised. A postal survey of beef cattle producers in Queensland who grow leucaena pastures was conducted. The questionnaire gathered information regarding: property location; extent and age of leucaena pastures; soil type; leucaena and grass establishment methodology; grazing and fertiliser management; and grazier perceptions of changes over time in leucaena productivity, grass growth and ground cover, prevalence of undesirable grasses and weeds, and livestock productivity. Graziers were asked to report on both young (≤10 years old) and aging (>10 years old) pastures under their management. Eighty-eight graziers responded describing 124 leucaena paddocks covering 11 750 ha. The survey results described the typical physical and management characteristics of leucaena pastures in Queensland. Graziers reported a decline in leucaena productivity in 58% of aging pastures, and declines in grass growth (32%) and livestock productivity (42%) associated with declining leucaena growth. Leucaena decline was greater in soil types of marginal initial fertility, particularly brigalow clay, soft wood scrub, downs and duplex soils. Maintenance fertiliser was not applied to most (98%) leucaena pastures surveyed despite significant amounts of nutrient removal, particularly phosphorus and sulphur, occurring over prolonged periods of moderate to high grazing pressure. It is predicted that large areas of leucaena pasture will continue to suffer soil nutrient depletion under current management practices. Research is needed to develop ameliorative actions to reinvigorate pasture productivity.

scholarly journals Determining barriers and facilitators to engagement for families in a family-based, multicomponent healthy lifestyles intervention for children and adolescents: a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037152 ◽  
Author(s):  
Cervantée EK Wild ◽  
Ngauru T Rawiri ◽  
Esther J Willing ◽  
Paul L Hofman ◽  
Yvonne C Anderson
Keyword(s):  
Healthy Lifestyle ◽  
Healthcare Services ◽  
Barriers And Facilitators ◽  
Negative Experiences ◽  
Service Levels ◽  
Participant Engagement ◽  
Home Based ◽  
Urban Rural ◽  
Family Based ◽  
Lifestyle Programme

ObjectivesRecruitment and retention in child and adolescent healthy lifestyle intervention services for childhood obesity is challenging, and inequalities across social groups are persistent. This study aimed to understand the barriers and facilitators to engagement in a multicomponent assessment-and-intervention healthy lifestyle programme for children and their families, based in the home and community.DesignQualitative interview-based study of past users (n=76) of a family-based multicomponent healthy lifestyle programme in a mixed urban–rural region of New Zealand. Semistructured, home-based interviews were conducted and thematically analysed with peer debriefing for validity.ParticipantsFamilies were selected through stratified random sampling to include a range of levels of engagement, including those who declined their referral, with equal numbers of interviews with Indigenous and non-Indigenous families.ResultsThree interactive and compounding determinants were identified as influencing engagement in Whānau Pakari: acute and chronic life stressors, societal norms of weight and body size and historical experiences of healthcare. These determinants were present across societal, system and healthcare service levels. A negative referral experience to Whānau Pakari often resulted in participants declining further input or disengaging from the programme. A fourth domain, respectful and compassionate healthcare, was identified as a mitigator of these three themes, facilitating participant engagement despite previous negative experiences.ConclusionsWhile participant engagement in healthy lifestyle programmes is affected by determinants which appear to operate outside immediate service provision, the programme is an opportunity to acknowledge past instances of stigma and the wider challenges of healthy lifestyle change. The experience of the referral to Whānau Pakari is important for setting the scene for future engagement in the programme. Respectful, compassionate care is critical to enhanced retention in multidisciplinary healthy lifestyle programmes and ongoing engagement in healthcare services overall.

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