A systematic approach for enhancing fidelity in opioid overdose prevention interventions

Abstract Background There is a high risk of death from opioid overdose following release from prison. Efforts to develop and implement overdose prevention programs for justice-involved populations have increased in recent years. An understanding of the gaps in knowledge on prevention interventions is needed to accelerate development, implementation, and dissemination of effective strategies. Methods A systematic search process identified 43 published papers addressing opioid overdose prevention in criminal justice settings or among justice-involved populations from 2010 to February 2020. Cross-cutting themes were identified, coded and qualitatively analyzed. Results Papers were coded into five categories: acceptability (n = 8), accessibility (n = 4), effectiveness (n = 5), feasibility (n = 7), and participant overdose risk (n = 19). Common themes were: (1) Acceptability of naloxone is associated with injection drug use, overdose history, and perceived risk within the situational context; (2) Accessibility of naloxone is a function of the interface between corrections and community; (3) Evaluations of overdose prevention interventions are few, but generally show increases in knowledge or reductions in opioid overdose; (4) Coordinated efforts are needed to implement prevention interventions, address logistical challenges, and develop linkages between corrections and community providers; (5) Overdose is highest immediately following release from prison or jail, often preceded by service-system interactions, and associated with drug-use severity, injection use, and mental health disorders, as well as risks in the post-release environment. Conclusion Study findings can inform the development of overdose prevention interventions that target justice-involved individuals and policies to support their implementation across criminal justice and community-based service systems.

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Pilot Study of an Overdose First Aid Program in Juvenile Detention

Health Promotion Practice ◽

10.1177/1524839920950028 ◽

2020 ◽

pp. 152483992095002

Author(s):

Stephanie Chambers ◽

Melanie Baca ◽

Ekaterina Navrotskaya ◽

Annemarie Madaras ◽

Robert L. Rhyne ◽

...

Keyword(s):

Pilot Study ◽

First Aid ◽

Juvenile Detention ◽

Future Research ◽

Opioid Overdose ◽

Opioid Use ◽

Overdose Prevention ◽

Telephone Interviews ◽

First Aid Training ◽

Prevention Interventions

Objectives The purpose of this study was to evaluate the feasibility and short-term impact of a brief opioid overdose prevention and mitigation training administered to detained youth at risk for witnessing an overdose. Methods Adolescents seen in the medical clinic in a youth detention center were screened to determine risk for witnessing an overdose. Eligible adolescents completed a pretraining assessment that included opioid witnessing experiences and knowledge of and attitudes toward opioid overdose prevention. Participants completed a one-on-one overdose first aid training, received a naloxone (Narcan) kit at release, and completed a posttraining assessment of knowledge and attitudes. At 1 month and 3 months postrelease, participants completed telephone interviews to report satisfaction and application of training concepts. Results A total of 39 adolescent residents participated in this pilot study. Rates of recruitment and retention, as well as high rates of witnessing opioid use and overdose, indicate that opioid overdose prevention interventions are warranted with this population. There were significant changes in knowledge, confidence, and readiness to intervene in an opioid overdose from pre- to posttraining. At follow-up, the majority of participants still possessed their naloxone, and all reported sharing information from the training with others and having a plan if they witnessed an overdose. One participant reported completion of an overdose reversal. Implications Opioid overdose prevention training with detained youth is feasible and shows promising impacts on knowledge and application, meriting the need for future research.

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Harm Reduction Interventions to Prevent Overdose Deaths

Canadian Journal of Health Technologies ◽

10.51731/cjht.2021.112 ◽

2021 ◽

Vol 1 (8) ◽

Author(s):

Jonathan Harris

Keyword(s):

Drug Use ◽

Harm Reduction ◽

Lived Experience ◽

Public Understanding ◽

Opioid Overdose ◽

Current Crisis ◽

Overdose Prevention ◽

Prevention Interventions ◽

Informal Supports ◽

Overdose Deaths

Overdose deaths have been occurring at high rates in many parts of Canada. From January 2016 (when national surveillance began) to March 2019, an estimated 12,800 Canadians died of an opioid overdose.1 In addition to opioid-related harms, stimulants such as methamphetamine have re-emerged in some regions and are also contributing to the current rise in overdose deaths. COVID-19 has resulted in a more compromised illicit drug supply, and those who use drugs have had limited access to formal and informal supports because of public health measures regarding physical distancing. As a result, overdose deaths have increased during the pandemic. Harm reduction approaches provide a mechanism to prevent overdose deaths and have additional health and public safety benefits. The current crisis has been exacerbated by COVID-19; therefore, it is an appropriate time to consider the entire continuum of harm reduction approaches available to reduce preventable overdose deaths. People with lived experience of drug use should be meaningfully included in policy discussions about harm reduction and overdose prevention interventions. This would enhance the person-centredness of programs and ensure they are reflective of the lived realities of those who use drugs. Although societal attitudes about drug use are changing, harm reduction interventions remain politically contentious. Countering stigma, being prepared to engage with community concerns, and clearly articulating that harm reduction services are intended to complement and not replace drug treatment are all important in enhancing public understanding of harm reduction.

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

Public Health Reports ◽

10.1177/00333549211026816 ◽

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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Hoots and harm reduction: a qualitative study identifying gaps in overdose prevention among women who smoke drugs

Harm Reduction Journal ◽

10.1186/s12954-021-00479-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Geoff Bardwell ◽

Tamar Austin ◽

Lisa Maher ◽

Jade Boyd

Keyword(s):

Harm Reduction ◽

Illicit Drugs ◽

Structural Violence ◽

Structured Interviews ◽

Overdose Prevention ◽

Polysubstance Use ◽

Reduction Strategies ◽

Prevention Interventions ◽

Negative Health Outcomes ◽

Mixed Gender

Abstract Background Smoking or inhaling illicit drugs can lead to a variety of negative health outcomes, including overdose. However, most overdose prevention interventions, such as supervised consumption services (SCS), prohibit inhalation. In addition, women are underrepresented at SCS and are disproportionately impacted by socio-structural violence. This study examines women’s experiences smoking illicit drugs during an overdose epidemic, including their utilization of a women-only supervised inhalation site. Methods Qualitative research methods included on-site ethnographic observation and semi-structured interviews with 32 participants purposively recruited from the women-only site. Data were coded and analyzed using NVivo 12 and thematic analysis was informed by gendered and socio-structural understandings of violence. Results Participants had preferences for smoking drugs and these were shaped by their limited income, inability to inject, and perceptions of overdose risk. Participants expressed the need for services that attend to women’s specific experiences of gendered, race-based, and structural violence faced within and outside mixed-gender social service settings. Results indicate a need for sanctioned spaces that recognize polysubstance use and drug smoking, accommodated by the women-only SCS. The smoking environment further fostered a sociability where participants could engage in perceived harm reduction through sharing drugs with other women/those in need and were able to respond in the event of an overdose. Conclusions Findings demonstrate the ways in which gendered social and structural environments shape women’s daily experiences using drugs and the need for culturally appropriate interventions that recognize diverse modes of consumption while attending to overdose and violence. Women-only smoking spaces can provide temporary reprieve from some socio-structural harms and build collective capacity to practice harm reduction strategies, including overdose prevention. Women-specific SCS with attention to polysubstance use are needed as well as continued efforts to address the socio-structural harms experienced by women who smoke illicit drugs.

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

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa387 ◽

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.

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Long-Term Effects of Opioid Overdose Prevention and Response Training on Medical Student Knowledge and Attitudes Toward Opioid Overdose: A Pilot Study

Addictive Behaviors ◽

10.1016/j.addbeh.2021.107172 ◽

2021 ◽

pp. 107172

Author(s):

Tabitha E.H. Moses ◽

Jody S. Chou ◽

Jessica L. Moreno ◽

Leslie H. Lundahl ◽

Eva Waineo ◽

...

Keyword(s):

Medical Student ◽

Pilot Study ◽

Opioid Overdose ◽

Long Term Effects ◽

Student Knowledge ◽

Overdose Prevention ◽

Knowledge And Attitudes ◽

Response Training

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Description of a pharmacist-led clinical video telehealth group clinic for opioid overdose prevention and naloxone education

Mental Health Clinician ◽

10.9740/mhc.2019.07.294 ◽

2019 ◽

Vol 9 (4) ◽

pp. 294-297

Author(s):

Aimee N. Jensen ◽

Candace M. Beam ◽

Amber R. Douglass ◽

Jennifer E. Brabson ◽

Michelle Colvard ◽

...

Keyword(s):

At Risk ◽

High Risk ◽

Rural Areas ◽

Urban Areas ◽

Patient Specific ◽

Opioid Overdose ◽

Overdose Prevention ◽

Innovative Practice ◽

Risk Patients ◽

Urban And Rural Areas

Abstract To achieve the nationwide goal of reducing opioid-related deaths, a clinical pharmacy specialist–led clinical video telehealth (CVT) clinic was created at a Veterans Affairs medical center (VAMC) to deliver opioid overdose prevention and naloxone education to at-risk patients. The purpose of this innovative practice was to improve access to this potentially life-saving intervention to patients across urban and rural areas. This study is a single-center, descriptive analysis of adult patients across 2 VAMC campuses and 4 community-based outpatient clinics from July 11, 2016, through December 31, 2016. The purpose of this innovative practice was to increase access to overdose education and naloxone distribution (OEND) to at-risk patients across urban and rural areas. Patient-specific factors were also examined among those receiving naloxone through the CVT clinic compared to other prescribers. During the first 6 months from the initiation of the clinic, 1 pharmacist prescribed 21% of the health care system's naloxone. These patients identified by the pharmacist-led CVT clinic were more likely to be considered high-risk due to concomitant use of opioids and benzodiazepines. In conclusion, the pharmacist-led CVT group clinic has been an efficient strategy to extend OEND services to high-risk patients beyond central, urban areas.

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