Overdose Management Training and Take-home Naloxone for Opiate-Using Persons May Save Lives
Opiate overdose is the cause of most drug-related mortality, and witnesses are commonly present. An initiative to provide training in the management of overdose was delivered to staff in 20 drug treatment facilities across England during 2005/2006. These staff then provided 239 opiate-using addiction treatment patients with training in management of overdose and a take-home supply of naloxone. The patients completed surveys before, immediately after, and 3 months after the training. At baseline, more than 90% of patients could recognize signs of opioid overdose. Among the 186 patients (78%) who completed 3-month follow-up,
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90% reported still using illicit opiates.
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over 96% recalled the correct intramuscular injection sites for the naloxone, 77% retained knowledge of the recovery breathing position, and >97% remained confident in their ability to recognize and manage an overdose.
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close to 80% retained their naloxone, and 28% had trained a friend or family member to administer it should the participant overdose.
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18 reported witnessing or experiencing an overdose during the 3-month period. Patients used their naloxone to revive other people on 10 occasions, and 2 received naloxone from ambulance staff.
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1 death resulted among the 6 overdoses where naloxone was not administered.
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no adverse reactions were reported.
Comments:
Despite the brief follow-up period and lack of a control group, this study suggests that addiction treatment patients can recognize and treat opiate overdose with intramuscular naloxone, which is easy to administer, safe, and life-saving. Overdose management training and naloxone distribution is a promising strategy to reduce the high rates of mortality among persons with opiate use disorders, especially those who have lost their tolerance as a result of detoxification or imprisonment. Although more definitive studies are needed, physicians are well-positioned to offer this very safe, life-saving option to opiate-dependent patients.
Peter D. Friedmann, MD, MPH
Reference:
Strang J, Manning V, Mayet S, et al. Overdose training and take-home naloxone for opiate users: prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses. Addiction. 2008;103(10):1648–1657.