Opioid Overdose Knowledge Research Articles

Naloxone access for Emergency Medical Technicians: An evaluation of a training program in rural communities

IntroductionOpioid-related overdose death rates in rural communities in the United States are much higher than their urban counterparts. However, basic life support (BLS) personnel, who are more common in rural areas, have much lower rates of naloxone administration than other levels of emergency medical services (EMS). Training and equipping basic level Emergency Medical Technician (EMTs) to administer naloxone for an opioid overdose could yield positive outcomes. MethodsFollowing a legislative change that allowed EMTs to administer naloxone in one rural state, we evaluated an EMT training program by examining EMTs' opioid overdose knowledge and attitudes before and after the training. ResultsOne-hundred-seventeen rural EMTs participated the training. They demonstrated statistically significant improvements on almost all of the knowledge questions after the training (p's = 0.0469 to <0.0001). The opioid overdose competency and concern scales showed statistically significant improvement (p < 0.0001) and reduction (p < 0.0001), respectively. Furthermore, statistically significant changes in knowledge and opinions of state law regarding naloxone administration were observed. Significantly more EMTs supported the idea of expanding naloxone to people at risk for overdose (p = 0.0026) after the training. ConclusionsAt a time when states are passing legislation to expand first responders' access to naloxone, this study provides evidence about authorizing EMTs to administer naloxone.

Opioid Overdose Education for Individuals Prescribed Opioids for Pain Management: Randomized Comparison of Two Computer-Based Interventions.

Opioid overdose (OD) rates in the United States have reached unprecedented levels. Current OD prevention strategies largely consist of distribution of naloxone and in-person trainings, which face obstacles to expedient, widespread dissemination. Web-based interventions have increased opioid-OD response knowledge in patients with opioid-use disorders; however, these interventions have not been tested in the larger population of individuals that are prescribed opioid analgesics. This study assessed a web-based intervention providing education across three knowledge domains: opioid effects, opioid-OD symptoms, and opioid-OD response. Participants (N = 197) were adults recruited on Amazon Mechanical Turk from May to June 2017, who were prescribed an opioid medication for pain. Participants were randomly assigned to a Presentation (n = 97) intervention communicating relevant facts in each knowledge domain, or a Presentation + Mastery (n = 100) intervention including the same facts but requiring that participants respond correctly to ≥80% of embedded questions in each module before advancing. Participants completed the Brief Opioid Overdose Knowledge (BOOK) measure before and after the interventions, and provided feedback on acceptability. Both versions of the intervention resulted in significant pre to postintervention increases in BOOK scores across all knowledge domains (p < 0.001), with no significant knowledge differences between groups. The Presentation intervention took significantly less time to complete (p < 0.001) and was completed by significantly more participants than the Presentation + Mastery intervention (p < 0.001). Most participants rated both interventions as highly acceptable. Results replicate a previous study (1) and suggest the web-based Presentation intervention may be a convenient, cost-effective method for disseminating crucial public health information for preventing opioid OD.

Overdose Education and Naloxone Distribution Program Attendees: Who Attends, What Do They Know, and How Do They Feel?

The United States is in the midst of an opioid overdose epidemic. Opioids killed more than 28 000 people in 2014, more than any year on record. One approach to addressing this growing epidemic is Opioid Overdose Education and Naloxone Distribution (OEND) training. Little is known about these programs' participants and their effectiveness across different demographic groups. To examine (1) whether knowledge and attitudes improved over the course of the training programs; (2) whether training outcomes differ by demographics; and (3) what overdose experiences do attendees have, and whether those experiences influence their knowledge and attitudes. A pre- and posttest survey was used to collect data on participants' demographics, overdose experiences, and opioid overdose knowledge and attitudes. Surveys that took place at community-wide OEND programs were offered throughout Erie County, New York, during October and November 2015. Community members who elected to attend the training programs, were at least 18 years of age, spoke English, and were willing and able to participate were included in the sample (N = 198). N/A. The Opioid Overdose Knowledge and Attitudes Scale. Knowledge and attitude scores significantly improved from pre- to posttest assessments, increasing by 23.1% and 15.4%, respectively (Ps < .001). There were significant demographic differences in knowledge and attitudes at the pretest assessment, but these differences were ameliorated by the OEND program and did not persist at posttest assessment. In addition, 62.9% of participants had never experienced, witnessed, or known someone who had overdosed. Results indicate that OEND programs are effective at improving knowledge and attitudes toward opioid overdose. These results indicate that OEND programs are not reaching the highest risk individuals but are instead attracting concerned family and significant others. Future programs should focus on reaching current opioid users, overdose victims, and their families to ensure OEND programs are reaching the target audiences.

Knowledge of Opioid Overdose and Attitudes to Supply of Take-Home Naloxone Among People with Chronic Noncancer Pain Prescribed Opioids.

Take-home naloxone (THN) is recommended in response to pharmaceutical opioid-related mortality. Some health professionals are reluctant to discuss THN for fear of causing offense. The aims of this study were to assess knowledge of opioid overdose and attitudes toward THN for opioid overdose reversal in people with chronic noncancer pain (CNCP). Prospective cohort study. Australia, September to October 2015. A subset of participants (N = 208) from a cohort of people prescribed restricted opioids for CNCP. Questions added in the two-year telephone interviews examined knowledge of overdose symptoms and attitudes toward community supply of naloxone. Associations with overdose risk factors and naloxone supply eligibility criteria with attitudes toward naloxone were explored. Fourteen percent reported ever experiencing opioid overdose symptoms. Participants correctly identified fewer than half of the overdose signs and symptoms. After receiving information on naloxone, most participants (60%), thought it was a "good" or "very good" idea. Few participants reported that they would be "a little" (N = 21, 10%) or "very" offended (N = 7, 3%) if their opioid prescriber offered them naloxone. Positive attitudes toward THN were associated with male gender (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.09-3.50), past year cannabis use (OR = 2.52, 95% CI = 1.03-6.16), and past year nicotine use (OR = 2.11, 95% CI = 1.14-3.91). Most participants had positive attitudes toward THN but low knowledge about opioid overdose symptoms. Strategies for educating patients and their caregivers on opioid toxicity are needed. THN may be best targeted toward those with risk factors in terms of overdose prevention and acceptability.

An interprofessional education workshop to develop health professional student opioid misuse knowledge, attitudes, and skills

ObjectiveTo implement and evaluate an interprofessional workshop focused on increasing student knowledge, skills, and attitudes toward opioid misuse. SettingThe Warren Alpert Medical School of Brown University in Providence, Rhode Island, April 2016. Practice descriptionHealth professional students from medicine, nursing, pharmacy, social work, and physical therapy participated in an interprofessional education workshop focused on opioid use disorder. Practice innovationThis workshop included 4 main components: a patient panel, a simulated standardized patient encounter, a paper-based case session focused on a homeless individual misusing opioids, and naloxone training. EvaluationDirect assessment included a pretest and a posttest adapted from the Opioid Overdose Knowledge Scale administered to medical students measuring knowledge of opioid overdose at baseline and at 12 weeks after the workshop. Indirect assessment included a satisfaction survey administered to medical, nursing, pharmacy, and social work students. ResultsMedical students scored a mean of 40.84 out of 54 (SD = 5.36) points at baseline (n = 120) and a mean of 47.94 out of 54 (SD = 3.20) points at 12-week follow-up (n = 72), demonstrating a significant increase in knowledge from pretest to posttest (P <0.001). Student satisfaction data from medicine, nursing, pharmacy, social work, and physical therapy (n = 272) revealed a high degree of satisfaction regarding the overall quality of the training (4.47/5; SD = 0.75), quality of instruction (4.53/5; SD = 0.73), quality of training materials (4.46/5; SD = 0.77), the training experience (4.52/5; SD = 0.75), and the organization of the training (4.50/5; SD = 0.73). ConclusionOur results demonstrate that an interprofessional education workshop focused exclusively on opioid misuse was well received with high levels of satisfaction among health professional students. Workshops such as these can be used in health professions curricula to simulate the complex issues surrounding substance use disorder and to highlight the importance of interprofessional teams.

Opioid Overdose History, Risk Behaviors, and Knowledge in Patients Taking Prescribed Opioids for Chronic Pain.

More than 100 million adults in the United States experience chronic pain, and prescription opioids are the third most widely prescribed class of medications. Current opioid overdose prevention efforts almost exclusively target illicit opioid users, and little is known about the experience of overdose among patients being treated for chronic pain (CP) with a prescription opioid. Patients experiencing CP for three or more months and receiving a prescription opioid for pain management (N = 502) completed a self-report survey that asked questions about opioid overdose history, past 30-day risk factors, and knowledge of opioid overdose, overdose risk, and naloxone. Approximately one in five CP participants reported experiencing a lifetime overdose. CP participants reported engaging in several behaviors associated with overdose risk and were unlikely to have been trained to administer naloxone. Fewer than 50% of participants answered any knowledge item correctly. The likelihood of having experienced an overdose increased as the scores on the SOAPP-R and DSM-5 opioid use disorder checklist increased, and a SOAPP-R score of 7 or higher or meeting DSM-5 mild opioid use disorder criteria were significantly associated with reporting a lifetime overdose (85% and 84% of participants who experienced an overdose, respectively). Opioid overdose occurs at a high rate among CP participants, and this group is relatively uninformed about risk factors for overdose. Established SOAPP-R and DSM thresholds provide an opportunity to identify participants at elevated risk for having experienced an opioid overdose. These data support development of additional concentrated efforts to prevent overdose among chronic pain patients.

Opioid Overdose Experience, Risk Behaviors, and Knowledge in Drug Users from a Rural Versus an Urban Setting

BackgroundOpioid use is highly prevalent in the United States and there has been an increased incidence in the rate of opioid-related overdose. While evidence suggests that there are substantial differences in opioid use among rural versus urban settings, the rate of overdose and corresponding frequency of opioid overdose risk behaviors and overdose knowledge between rural and urban settings have not been examined. MethodsIndividuals with opioid use disorder from rural (N=98) and urban (N=247) settings completed a self-report survey regarding their lifetime history of overdose and overdose risk behaviors. Participants also completed the Brief Opioid Overdose Knowledge (BOOK) questionnaire, a 12-item self-report measure of opioid overdose knowledge. ResultsOverall, 35.6% of participants had experienced an overdose, and prevalence of overdose was significantly higher (p<.01) among rural (45.9%) vs. urban (31.6%) participants, though fewer rural participants reported past 30-day risk behaviors. There were few differences observed between the subset of rural and urban participants who had experienced an overdose, and fewer rural participants with a history of overdose reported past 30-day risk behaviors. Both rural and urban participants performed poorly on the BOOK, though the percent of correct responses was lowest among rural participants with a history of overdose. ConclusionResults demonstrate higher rates of overdose among rural opioid users, though rural participants were less likely to report recent risk behaviors. Results also suggest that knowledge regarding key factors related to opioid overdose is severely lacking, particularly among rural opioid users, which could be a potential target for future intervention efforts.

Brief Opioid Overdose Knowledge (BOOK): A Questionnaire to Assess Overdose Knowledge in Individuals Who Use Illicit or Prescribed Opioids.

Background:Opioid overdose is a public health crisis. This study describes efforts to develop and validate the Brief Opioid Overdose Knowledge (BOOK) questionnaire to assess patient knowledge gaps related to opioid overdose risks.Methods:Two samples of illicit opioid users and a third sample of patients receiving an opioid for the treatment of chronic pain (total N = 848) completed self-report items pertaining to opioid overdose risks.Results:A 3-factor scale was established, representing Opioid Knowledge (4 items), Opioid Overdose Knowledge (4 items), and Opioid Overdose Response Knowledge (4 items). The scale had strong internal and face validity. Patients with chronic pain performed worse than illicit drug users in almost all items assessed, highlighting the need to increase knowledge of opioid overdose risk to this population.Conclusions:This study sought to develop a brief, internally valid method for quickly assessing deficits in opioid overdose risk areas within users of illicit and prescribed opioids, to provide an efficient metric for assessing and comparing educational interventions, facilitate conversations between physicians and patients about overdose risks, and help formally identify knowledge deficits in other patient populations.

Training law enforcement to respond to opioid overdose with naloxone: Impact on knowledge, attitudes, and interactions with community members

BackgroundTraining law enforcement officers (LEOs) to administer naloxone to opioid overdose victims is increasingly part of comprehensive efforts to reduce opioid overdose deaths. Such efforts could yield positive interactions between LEOs and community members and might ultimately help lower overdose death rates. MethodsWe evaluated a pilot LEO naloxone program by (1) assessing opioid overdose knowledge and attitudes (competency in responding, concerns about naloxone administration, and attitudes towards overdose victims) before and after a 30min training on overdose and naloxone administration, and (2) conducting qualitative interviews with LEOs who used naloxone to respond to overdose emergencies after the training. ResultsEighty-one LEOs provided pre- and post-training data. Nearly all (89%) had responded to an overdose while serving as an LEO. Statistically significant increases were observed in nearly all items measuring opioid overdose knowledge (p’s=0.04 to <0.0001). Opioid overdose competencies (p<0.001) and concerns about naloxone administration (p<0.001) significantly improved after the training, while there was no change in attitudes towards overdose victims (p=0.90). LEOs administered naloxone 11 times; nine victims survived and three of the nine surviving victims made at least one visit to substance abuse treatment as a result of a LEO-provided referral. Qualitative data suggest that LEOs had generally positive experiences when they employed the skills from the training. ConclusionsTraining LEOs in naloxone administration can increase knowledge and confidence in managing opioid overdose emergencies. Perhaps most importantly, training LEOs to respond to opioid overdose emergencies may have positive effects for LEOs and overdose victims.

Improving Outcomes of Opioid Overdose: Preparing Nursing Students to Intervene.

Death by overdose has been steadily increasing since 1992 and has become a public health epidemic. With the rise of prescription pain medications for nonmedical use and the highest use of illicit substances by those ages 18-25, the need for action is imperative. The aim of the study was to determine whether an educational intervention had an effect on nursing students' knowledge and skills regarding administration of intranasal naloxone for opioid overdose. A convenience sample of baccalaureate nursing students was recruited for the study. A pretest/posttest design was used to evaluate the educational intervention. A paired t test was used to compare differences in pre- and posttest scores. A total of 49 students completed the study. The majority were women ages 25 and below, 31 (63.2%) had some or no background knowledge of opioid overdose, and 42 (85.7%) had not received previous training on intranasal naloxone. Student knowledge increased significantly (p < .001) following the educational intervention. Twenty-four students requested hands-on training for implementation of the intranasal naloxone and scored 100% accuracy in return demonstration. Implementation of this brief training was effective for increasing the knowledge of opioid overdose for an at-risk population. The nursing student is in a unique position to educate, train, and intervene for peers, friends, and family members who are at high risk for an opiate overdose. Nursing students have a pronounced advantage to assess for respiratory depression and initiate CPR, thereby interrupting a fatal overdose.

Development and process evaluation of an educational intervention for overdose prevention and naloxone distribution by general practice trainees.

BackgroundOverdose is the most common cause of fatalities among opioid users. Naloxone is a life-saving medication for reversing opioid overdose. In Ireland, it is currently available to ambulance and emergency care services, but General Practitioners (GP) are in regular contact with opioid users and their families. This positions them to provide naloxone themselves or to instruct patients how to use it. The new Clinical Practice Guidelines of the Pre-hospital Emergency Care Council of Ireland allows trained bystanders to administer intranasal naloxone.We describe the development and process evaluation of an educational intervention, designed to help GP trainees identify and manage opioid overdose with intranasal naloxone.MethodsParticipants (N = 23) from one postgraduate training scheme in Ireland participated in a one-hour training session. The repeated-measures design, using the validated Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales, examined changes immediately after training. Acceptability and satisfaction with training were measured with a self-administered questionnaire.ResultsKnowledge of the risks of overdose and appropriate actions to be taken increased significantly post-training [OOKS mean difference, 3.52 (standard deviation 4.45); P < 0.001]; attitudes improved too [OOAS mean difference, 11.13 (SD 6.38); P < 0.001]. The most and least useful delivery methods were simulation and video, respectively.ConclusionAppropriate training is a key requirement for the distribution of naloxone through general practice. In future studies, the knowledge from this pilot will be used to inform a train-the-trainer model, whereby healthcare professionals and other front-line service providers will be trained to instruct opioid users and their families in overdose prevention and naloxone use.

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

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.

Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users

BackgroundIn an effort to increase effective intervention following opioid overdose, the New York State Department of Health (NYSDOH) has implemented programs where bystanders are given brief education in recognizing the signs of opioid overdose and how to provide intervention, including the use of naloxone. The current study sought to assess the ability of NYSDOH training to increase accurate identification of opioid and non-opioid overdose, and naloxone use among heroin users. MethodsEighty-four participants completed a test on overdose knowledge comprised of 16 putative overdose scenarios. Forty-four individuals completed the questionnaire immediately prior to and following standard overdose prevention training. A control group (n=40), who opted out of training, completed the questionnaire just once. ResultsOverdose training significantly increased participants’ ability to accurately identify opioid overdose (p<0.05), and scenarios where naloxone administration was indicated (p<0.05). Training did not alter recognition of non-opioid overdose or non-overdose situations where naloxone should not be administered. ConclusionsThe data indicate that overdose prevention training improves participants’ knowledge of opioid overdose and naloxone use, but naloxone may be administered in some situations where it is not warranted. Training curriculum could be improved by teaching individuals to recognize symptoms of non-opioid drug over-intoxication.

Development of Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales for take-home naloxone training evaluation

AimsTo develop an Opioid Overdose Knowledge Scale (OOKS) and an Opioid Overdose Attitudes Scale (OOAS) to evaluate take-home naloxone training. MethodsPsychometric instrument development study conducted in England using convenience samples. Forty-five items were selected for the OOKS organised in four sub-scales (risks, signs, actions and naloxone use). The OOAS was formed initially of 32 items grouped in three sub-scales (competence, concerns and readiness). Both scales were administered to 42 friends and family members of heroin users and 56 healthcare professionals to assess internal reliability and construct validity. The Brief Overdose Recognition and Response Assessment (BORRA) and the General Self-Efficacy Scale (GSE) were also administered to family members to test concurrent validity. Family members completed the OOKS and OOAS on a second occasion to assess test–retest reliability. ResultsThe OOKS and OOAS were internally reliable (Cronbach's alpha=0.83 and 0.90, respectively). Retest was completed by 33 participants after 14 (SD 7) days (OOKS, ICC=0.90 and OOAS, ICC=0.82) with sub-scale item sets from each measure falling within the fair-to-excellent range (ICC=0.53–0.92). Professionals reported significantly higher scores on both scales than family members. The OOKS total score was positively correlated with the BORRA's Overdose Recognition (r=0.5, P<0.01) and Naloxone Indication sub-scales (r=0.44, P<0.05), but the total score on the OOAS was not associated with the GSE (r=0.02, NS). ConclusionThe 45-item OOKS and 28-item OOAS are suitable as outcome measures of take-home naloxone training for friends and family members of opioid users.

Psychosocial and contextual correlates of opioid overdose risk among drug users in St. Petersburg, Russia

BackgroundOpioid overdose in Russia is a problem that has grown more severe as heroin abuse expanded over the past decade, yet few studies have explored it in detail. In order to gain a clearer understanding of the situation, 60 drug users, both in and out of drug treatment in St. Petersburg, were interviewed concerning their overdose experience and knowledge about overdose recognition and prevention.MethodsUsing a semi-structured interview, we sought to identify and describe local attitudes, knowledge and experience (both self-sustained and witnessed) of opioid overdose. Bi-variate and multiple logistic regressions were performed in order to identify the relationship between overdose experience and sociodemographic factors, risk behaviors, and clinical psychiatric measures.ResultsWe found that having experienced or witnessed an opioid overdose within the previous year was common, overdose knowledge was generally high, but nearly half the participants reported low self-efficacy for effectively intervening in an overdose situation. In bivariate analyses, self-reported family problems (i.e., perceived problematic family interactions) were positively associated with both experiencing (t56 = 2.49; p < 0.05) and with witnessing a greater number of overdoses in the previous year (rhos = 0.31; p < 0.05). Having previously overdosed [Adjusted Risk Ratio (ARR) 1.7, 95% Confidence Interval (CI) 1.1–2.6] and higher SCL-90-R somatization scores (ARR 1.2, 95% CI 0.96 – 1.5) were independently associated in multivariable analyses with self-sustained overdose experience in the past year. Greater perceived likelihood of experiencing a future overdose and concern about medical problems were independently associated with witnessing a higher number of overdoses within the previous year. Over two thirds of the participants expressed interest in receiving training in overdose prevention and response.ConclusionOpioid overdose experience is very common among drug users in St. Petersburg, Russia, and interest in receiving training for overdose recognition and prevention was high. Future research should target the development of effective overdose recognition and prevention interventions, especially ones that include naloxone distribution and involve drug users' families.