Abstract
BackgroundFatal heroin overdose is a significant cause of mortality for injection drug users (IDUs). Many of these deaths are preventable because opiate overdoses can be quickly and safely reversed through the injection of Naloxone [brand name Narcan], a prescription drug used to revive persons who have overdosed on heroin or other opioids. Currently, in several cities in the United States, drug users are being trained in naloxone administration and given naloxone for immediate and successful reversals of opiate overdoses. There has been very little formal description of the challenges faced in the development and implementation of large-scale IDU naloxone administration training and distribution programs and the lessons learned during this process.MethodsDuring a one year period, over 1,000 participants were trained in SKOOP (Skills and Knowledge on Opiate Prevention) and received a prescription for naloxone by a medical doctor on site at a syringe exchange program (SEP) in New York City. Participants in SKOOP were over the age of 18, current participants of SEPs, and current or former drug users. We present details about program design and lessons learned during the development and implementation of SKOOP. Lessons learned described in the manuscript are collectively articulated by the evaluators and implementers of the project.ResultsThere were six primary challenges and lessons learned in developing, implementing, and evaluating SKOOP. These include a) political climate surrounding naloxone distribution; b) extant prescription drug laws; c) initial low levels of recruitment into the program; d) development of participant appropriate training methodology; e) challenges in the design of a suitable formal evaluation; and f) evolution of program response to naloxone.ConclusionOther naloxone distribution programs may anticipate similar challenges to SKOOP and we identify mechanisms to address them. Strategies include being flexible in program planning and implementation, developing evaluation instruments for feasibility and simplicity, and responding to and incorporating feedback from participants.
Highlights
Fatal heroin overdose is a significant cause of mortality for injection drug users (IDUs)
These insights are collectively articulated, discussed and summarized by both the evaluators and implementers on the project. This diverse team included the medical director on site at the syringe exchange program (SEP) who provided Skills and Knowledge on Overdose Prevention Project (SKOOP) training for SEP staff, prescriptions and medical histories for participants, and liaison with the external evaluators; external evaluators who assisted with study and survey design and implementation; project managers who trained and supervised survey interviewers and coordinated the overall programmatic efforts; and the administrator at Harm Reduction Coalition who had
The team identified six primary challenges and lessons learned from SKOOP, including: a) political climate of naloxone distribution b) extant prescription drug laws; c) initial low levels of recruitment into the program; d) training methodology modifications; e) conducting a formal evaluation; and f) evolution of program response to naloxone
Summary
Fatal heroin overdose is a significant cause of mortality for injection drug users (IDUs). In New York City (NYC), an estimated 900 opiate users die from overdose each year, a figure that exceeds the number of deaths from homicide [6,7] Many of these deaths are preventable because opiate overdoses can be quickly and safely reversed through the injection of Naloxone [brand name narcan], a prescription drug used to revive someone who has overdosed on heroin or other opioids. While the prevalence of opiate overdose mortality and the role of naloxone in opiate overdose prevention are gaining increased public health-related attention, there has been limited formal description of the development, implementation and evaluation of a largescale naloxone administration training and distribution programs to IDUs and the lessons learned during this process [12,15]
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