Abstract
Overdose Education and Naloxone Distribution (OEND) is an effective public health intervention to reduce opioid overdose fatalities (McDonald and Strang, Addiction 111:1177–1187, 2016). However, we know little about OEND implementation outcomes (i.e., indicators of implementation success), specifically the fidelity of training delivery, and how these may relate to intervention outcomes (i.e., indicators of the success or effectiveness of an intervention), such as overdose knowledge and attitudes. This study evaluated 16 OEND trainings conducted at different Opioid Overdose Prevention Programs in New York City. Trainees (N = 75) completed the Opioid Overdose Knowledge and Attitude Scales before and after training (intervention outcomes). Implementation outcomes were fidelity (competence and adherence of the trainer, N = 10; modified Fidelity Checklist) and acceptability of OEND (Acceptability of Intervention Measure), assessed from multiple perspectives (trainees, trainers, and an independent observer). Trainees’ overdose knowledge, t(71) = − 8.12, p < 0.001, 95% CI [− 6.54, − 3.96], and attitudes, t(65) = − 6.85, p < 0.001, 95% CI [− 0.59, − 0.33], improved significantly from pre- to post-training. Stepwise multiple regression models indicated that adherence of the trainer rated from the observer perspective added significantly to the prediction of changes in overdose knowledge, F(1, 67) = 9.81, p = 0.003, and explained 13% of the variance in outcome. However, fidelity measures from the perspective of trainees or trainers and acceptability of OEND were not associated with changes in trainees’ overdose knowledge or attitudes. OEND implementation outcomes and their relationship with intervention outcomes differed depending on the role of the fidelity rater in relation to the intervention. Specifically, our findings indicate that fidelity should be measured from an independent perspective (i.e., an individual who is experienced with fidelity rating but not directly involved in the intervention).
Highlights
Opioid‐Related Overdose Deaths and Targeted ResponseReducing fatal opioid overdoses remains a major challenge for public health
The current study aimed to evaluate the fidelity of Overdose Education and Naloxone Distribution (OEND) implementation in New York City (NYC)
B unstandardized regression coefficient; SE standard error a Change in Opioid Overdose Knowledge Scale (OOKS) sum scores from pre- to post-training b Length of the training session in minute c Change in Opioid Overdose Attitudes Scale (OOAS) mean scores from pre- to post-training d Trainees’ previous experience with training
Summary
Opioid‐Related Overdose Deaths and Targeted ResponseReducing fatal opioid overdoses remains a major challenge for public health. Drug overdose continues to be one of the main causes of death among people who use substances, and opioids are present in most overdose cases (Mattson et al, 2021). Global Implementation Research and Applications (2021) 1:209–222 opioid-related overdose deaths were reported in the United States (US) (Mattson et al, 2021). Many opioid overdose deaths are preventable, using a comprehensive approach that includes prevention, treatment of opioid use disorder, and raising public awareness (Levine & Fraser, 2018). Naloxone is a short-acting opioid receptor antagonist effective in counteracting the respiratory depression that can lead to death during opioid overdose (White & Irvine, 1999) and has an excellent pharmacological safety profile (i.e., side effects from naloxone are rare) (Sporer et al, 1996; Wermeling, 2015; Yealy et al, 1990)
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