Training family members to manage heroin overdose and administer naloxone: randomized trial of effects on knowledge and attitudes

Abstract

To evaluate a heroin overdose management training programme for family members based on emergency recovery procedures and take-home naloxone (THN) administration. A two-group, parallel-arm, non-blinded, randomized controlled trial of group-based training versus an information-only control. Training events delivered in community addiction treatment services in three locations in England. A total of 187 family members and carers allocated to receive either THN training or basic information on opioid overdose management (n = 95 and n = 92, respectively), with 123 participants completing the study. The primary outcome measure was a self-completion Opioid Overdose Knowledge Scale (OOKS; range 0-45) and an Opioid Overdose Attitudes Scale (OOAS; range 28-140) was the secondary outcome measure. Each group was assessed before receiving their assigned condition and followed-up 3 months after. Events of witnessing and managing an overdose during follow-up were also recorded. At follow-up, study participants who had received THN training reported greater overdose-related knowledge relative to those receiving basic information only [OOKS mean difference, 4.08 (95% confidence interval, 2.10-6.06; P < 0.001); Cohen's d = 0.74 (0.37-1.10)]. There were also more positive opioid overdose-related attitudes among the trained group at follow-up [OOAS mean difference, 7.47 (3.13-11.82); P = 0.001; d = 0.61 (0.25-0.97)]. At the individual level 35 and 54%, respectively, of the experimental group increased their knowledge and attitudes compared with 11 and 30% of the control group. During follow-up, 13 participants witnessed an overdose with naloxone administered on eight occasions: five among the THN-trained group and three among the controls. Take-home naloxone training for family members of heroin users increases opioid overdose-related knowledge and competence and these benefits are well retained after 3 months.