Drug users can be trained to identify opioid overdoses

[Paracelsus]

I found this interesting, as there is very little other research done about these training programs which include giving naloxone to addicts. This study only focused on how well trained drug users can identify opioid overdose. Unfortunately, this and the only other relevant study that I am aware of (Journal of Urban Health 2005 Jun;82(2):303-11) use very low sample sizes.

www.medicalnewstoday.com/articles/105986.php

Drug users can be taught to identify and quickly respond to overdoses of heroin or other opioids as effectively as medical experts, a Yale University study suggests.

The study supports efforts of some drug counselors, physicians and public health experts who have started community-based programs to train addicts and supply them with the opioid antagonist drug naloxone in order to respond to potentially fatal drug overdoses.

Naxolone, a medication lacking in abuse potential and routinely used by emergency medical personnel to treat heroin and other opioid overdoses, can be administered by a simple muscular injection. The drug temporarily combats effects of an overdose until medical help can arrive. Critics of such a harm-reduction strategy, however, have questioned whether drug users have the ability to recognize an overdose and can properly administer the drug. This study, recently published in the early online edition of the journal Addiction, suggests this concern is unwarranted.

"You have to keep people alive long enough to get access to drug treatment for their addiction,'' said Traci Craig Green, a doctoral candidate in the Yale School of Public Health and lead author of the research "You can't treat a dead person."

Ten individuals who were regular users of heroin or other opioid drugs such as oxycodone or hydromorphone were enrolled in the study at each of six sites across the United States. They were divided into two groups, one with members who had previously received training in overdose response and one with members who had not. Individuals were interviewed to determine if they could recognize signs of opioid overdose and when it was appropriate to administer naloxone. Their responses were then compared to those given by a group of medical experts.

The training, conducted well before the interviews were done, included recognizing differences between overdoses caused by opioids and those caused by other substances such as cocaine, for which use of the drug naloxone is not indicated.

"The study shows opioid users with training can spot an opioid overdose, are less likely to miss true opioid overdoses, and can determine whether naloxone should be administered and when it should not be administered,'' Green said.

The study was funded by the National Institute of Mental Health. Other authors included Robert Heimer and Lauretta E. Grau from the school of public health.

Green TC, Heimer R, Grau LE. Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States. Addiction 2008 Apr 16 [Epub ahead of print]

Aims This study assessed overdose and naloxone administration knowledge among current or former opioid abusers trained and untrained in overdose-response in the United States. Design and participants Ten individuals, divided equally between those trained or not trained in overdose recognition and response, were recruited from each of six sites (n = 62). Setting US-based overdose training and naloxone distribution programs in Baltimore, San Francisco, Chicago, New York and New Mexico. Measurements Participants completed a brief questionnaire on overdose knowledge that included the task of rating 16 putative overdose scenarios for: (i) whether an overdose was occurring and (ii) if naloxone was indicated. Bivariate and multivariable analyses compared results for those trained to untrained. Responses were also compared to those of 11 medical experts using weighted and unweighted kappa statistics. Findings Respondents were primarily male (72.6%); 45.8% had experienced an overdose and 72% had ever witnessed an overdose. Trained participants recognized more opioid overdose scenarios accurately (t(60) = 3.76, P < 0.001) and instances where naloxone was indicated (t(59) = 2.2, P < 0.05) than did untrained participants. Receipt of training and higher perceived competency in recognizing signs of an opioid overdose were associated independently with higher overdose recognition scores. Trained respondents were as skilled as medical experts in recognizing opioid overdose situations (weighted kappa = 0.85) and when naloxone was indicated (kappa = 1.0). Conclusions Results suggest that naloxone training programs in the United States improve participants' ability to recognize and respond to opioid overdoses in the community. Drug users with overdose training and confidence in their abilities to respond may effectively prevent overdose mortality.