Bystanders Taught to Treat Opioid OD

ACEP News
February 2011

Bystanders Taught to Treat Opioid OD 

BY BRUCE JANCIN 

Elsevier Global Medical News

DENVER - A novel Massachusetts program that shows bystanders how to administer intranasal naloxone has promise for the treatment of potentially fatal opioid overdoses.

The program was implemented in response to a greater than sixfold increase in the annual number of opioid-related fatal overdoses in Massachusetts from 1990 to 2006. Among 25- to 34-year-olds in Massachusetts, mortality attributable to opioid overdose is greater than that attributable to motor vehicle accidents, Courtney E. Pierce observed at the annual meeting of the American Public Health Association.

This is a national problem fostered by the ready availability of relatively low-cost, high-purity heroin along with the marked growth in opioid prescriptions, some of which are diverted for recreational use as street drugs. That's why the Centers for Disease Control and Prevention is funding the ongoing 2-year Intranasal Naloxone and Prevention Education's Effect on Overdose (INPEDE OD) study.

The INPEDE OD study is comparing opioid overdose rates, fatal and nonfatal, in those high-risk Massachusetts communities that have implemented bystander-administered intranasal naloxone to rates in other high-risk communities that have not, explained Ms. Pierce of the section of general internal medicine at Boston Medical Center.

Bystander-given intranasal naloxone for reversal of opioid overdoses was implemented by the Boston Health Commission in August 2006. Based upon the favorable Boston experience over a 15-month period, the state health department implemented a structured program of overdose education and distribution of intranasal naloxone kits in seven additional sites across the state.

The program is implemented by community-based HIV risk-reduction programs or public health agencies. It entails 1 hour of training in how to recognize signs of overdose, administer intranasal naloxone, and contact emergency medical services. Participants are then given a two-dose kit and encouraged to keep it on their person.

To date, nearly 8,000 potential bystanders have been enrolled. These are individuals considered particularly likely to encounter overdoses. They have been enrolled mostly at detox centers, methadone clinics, needle exchange sites, emergency departments, shelters, and drop-in centers. Among the enrollees are 5,351 individuals in treatment for, recovery from, or current active users of illicit drugs and 2,589 nonuser family members and other professionals.

At enrollment, 78% of people in the active- or past-use group and 47% of the nonusers had previously witnessed an overdose.

At last follow-up, 755 overdoses have been reversed through bystander-administered intranasal naloxone. In two-thirds of cases, the opioid antagonist was administered by a friend, in 14% by a partner or family member, and in 9% by a stranger. A total of 77% of these events took place in private settings. However, the bystander called 911 in only 34% of cases; this low rate is attributed to concern on the part of many bystanders that if they called the authorities, they risked arrest for illicit drug possession.

Naloxone is a Food and Drug Administration-approved drug with no abuse potential. Intranasal naloxone given as a spray via a mucosal atomizer is an off-label use. However, it's easily administered and has been essentially problem free in the Massachusetts experience, according to Ms. Pierce.

The expectation is that the INPEDE OD study will demonstrate that bystander-administered intranasal naloxone saves lives and prevents trips to the emergency department. If so, the plan is to expand the number of participating sites and seek passage of a state Good Samaritan law providing bystanders with immunity from prosecution, she said.

Ms. Pierce stated that she has no relevant financial interests.

 
 
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