Abstract
BackgroundOpioid overdose related injury or death can be prevented by bystander naloxone administration. For naloxone to be present when and where overdoses occur, opioid prevention education and naloxone distribution (OPEND) must be established on a broad level. This is the 30-month follow-up of the first multi-site naloxone project in Sweden, implemented at 31 sites in the County of Skåne 2018.AimTo address participant characteristics and factors associated with returning for naloxone refill and with having used naloxone for overdose reversal. An additional aim was to describe self-reported reasons for naloxone refill and overdose experiences.MethodsData were collected during June 2018—December 2020 through questionnaires at baseline and upon naloxone refill of the initial and subsequent naloxone kit. Descriptive statistics was used to address participant characteristics, those returning for naloxone refill and reporting overdose reversal. Chi-2 test was used for variable comparison between groups. Factors associated with overdose reversals were examined by logistic regression analysis. Reasons for naloxone refill, overdose situation and management were presented descriptively.ResultsAmong 1,079 study participants, 22% (n = 235) returned for naloxone refill, of which 60% (n = 140) reported a total of 229 overdose reversals. Reversals were more likely to be reported by participants trained at needle exchange programs (NEPs) [adjusted odds ratio (AOR) = 5.18, 95% Confidence interval (CI) = 3.38–7.95)], with previous experience of own (AOR = 1.63, 95% CI = 1.03–2.58) or witnessed (AOR = 2.12, 95% CI = 1.05–4.29) overdose, or who had used sedatives during the last 30 days before initial training (AOR = 1.56, 95% CI = 1.04–2.33). A majority of overdoses reportedly occurred in private settings (62%), where the victim was a friend (35%) or acquaintance (31%) of the rescuer.ConclusionParticipants with own risk factors associated with overdose (e.g., injection use, concomitant use of benzodiazepines and previous experience of own overdose) were more likely to report administering naloxone for overdose reversal. Overdose management knowledge was high. The findings indicate that implementation of multi-site OPEND reaches individuals at particularly high risk of own overdose in settings with limited previous harm reduction strategies and favors a further scaling up of naloxone programs in similar settings.
Highlights
Drug related deaths (DRDs) have increased during the last decades [1], where opioids, used alone or together with other drugs, are present in a majority of the cases [2], and is the single most common cause of death among individuals with opioid use disorder (OUD) [3]
Patients are given information material to pass on to others and are encouraged to inform others on how to identify an opioid overdose, what to do in case of witnessing an overdose, and where their naloxone is kept
The results from this study show that a large proportion of participants returned for naloxone refill and reported naloxone administration for overdose reversal implying that this naloxone project did reach a proportion of at-risk individuals efficiently
Summary
Drug related deaths (DRDs) have increased during the last decades [1], where opioids, used alone or together with other drugs, are present in a majority of the cases [2], and is the single most common cause of death among individuals with opioid use disorder (OUD) [3]. Key strategies for reducing the harms of OUD include increasing availability and access to NEPs [4, 5], opioid substitution treatment (OST) [6–10], drug consumption rooms [5, 11, 12], and overdose prevention education and naloxone distribution (OPEND) [3, 13–17]. Since the mid 1990’s naloxone use has gradually changed from medical professionals reversing opioid overdoses in acute medical settings to being a part of harm reduction interventions including training and distributing naloxone for the use of laypersons. For naloxone to be present when and where overdoses occur, opioid prevention education and naloxone distribution (OPEND) must be established on a broad level. This is the 30-month follow-up of the first multi-site naloxone project in Sweden, implemented at 31 sites in the County of Skåne 2018
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