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Gibbons JB, Sugarman OK, Byrne L, Harris SJ, Shah H, Hulsey EG, Rwan J, Rosner EM, Pantaleo A, Bergquist E, Saloner B. Perceptions of a naloxone leave behind program among emergency medical services personnel in Michigan, USA. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100273. [PMID: 39262666 PMCID: PMC11387810 DOI: 10.1016/j.dadr.2024.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 09/13/2024]
Abstract
Introduction In 2020, Michigan implemented its first Naloxone Leave-Behind Program for Emergency Medical Service (EMS) field providers. Under the program, EMS field providers leave naloxone kits to individuals aged 15 or older they encounter in the field who have overdosed, who indicate they have a substance use disorder, or exhibit signs of opioid use and/or to bystanders, friends, or family that are present at the encounter. Methods Survey of EMS field providers and administrators to assess perspectives on the Michigan NLB program. Comparisons of perspectives between field providers and administrators working in EMS agencies operating in medical control authorities (MCAs) participating in the NLB program (i.e., participating agencies) with field providers and administrators working for EMS agencies serving non-participating MCAs. Results Most EMS field providers and administrators supported the Michigan NLB program. However, some were concerned about the unintended consequences of leaving behind naloxone, including the potential for recipients to use more drugs or be less likely to seek treatment. Perspectives of NLB program effectiveness were similar between EMS administrators and field providers. Participating administrators' top-cited barrier to implementation was convincing field providers to leave behind naloxone, while non-participating administrators were concerned with stocking naloxone kits. Conclusions Additional engagement and training to address concerns by EMS field providers and administrators about the benefits of the NLB program are needed to expand program participation intensity. Streamlining naloxone procurement and increasing messaging about free access to naloxone for participating in the program may help increase adoption.
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Affiliation(s)
- Jason Brian Gibbons
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Olivia K Sugarman
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns, Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Lauren Byrne
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns, Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Samantha J Harris
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns, Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Hridika Shah
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns, Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Eric G Hulsey
- Overdose Prevention Program, Vital Strategies, 100 Broadway, 4th Floor, New York, NY, 10005, USA
| | - Julie Rwan
- Overdose Prevention Program, Vital Strategies, 100 Broadway, 4th Floor, New York, NY, 10005, USA
| | - Esther Mae Rosner
- Overdose Prevention Program, Vital Strategies, 100 Broadway, 4th Floor, New York, NY, 10005, USA
| | | | | | - Brendan Saloner
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns, Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
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van Draanen J, Adwell A, Wettemann C, Fockele CE, Goh B, Perlmutter DL, Williams GW, Holland N, Frohe T. "You might be nice, but where you take me, they're not gonna be": Preferences for field-based post-overdose interventions. Drug Alcohol Rev 2024. [PMID: 39205432 DOI: 10.1111/dar.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Emergency medical services (EMS) systems are piloting interventions to respond to overdoses with additional services such as leave-behind naloxone and medication for opioid use disorder, but little is known about the perspectives of people who use drugs (PWUD) on these interventions being delivered by EMS during an overdose response. METHODS The Consolidated Framework for Implementation Research guided the development of data collection tools, the analytic strategy and the organisation of results. A community engaged method was used which included both academically trained researchers and community trained researchers who are also PWUD. This study used semi-structured interviews to gather data from 13 PWUD in King County, Washington in June 2022. Data were analysed using thematic analysis. RESULTS The people interviewed for this study viewed EMS distribution of leave-behind naloxone and field-based buprenorphine favourably. They viewed EMS facilitation of hepatitis C virus and HIV testing in the field less favourably and were concerned about stigmas associated with those results. Additional themes emerged regarding: the need for different approaches to post-overdose care; the need for new services, including post-overdose trauma counselling and an alternative destination to the emergency department; and the harms of law enforcement presence at overdose responses. DISCUSSION AND CONCLUSIONS This study found strong support for leave-behind naloxone and field-initiated buprenorphine. Further training for EMS should include trauma-informed care and strategies to address burnout and increase compassion. Alternatives to the emergency department as a post-overdose destination are needed. These strategies should be considered by jurisdictions revising overdose response protocols.
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Affiliation(s)
- Jenna van Draanen
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Addy Adwell
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
| | - Courteney Wettemann
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
- Research with Expert Advisors on Drug Use, Seattle, USA
| | | | - Brenda Goh
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - David L Perlmutter
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | | | | | - Tessa Frohe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
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Thompson RL, Sabounchi NS, Ali SS, Heimer R, D'Onofrio G, Heckmann R. Using qualitative system dynamics modeling to understand overdose bystander behavior in the context of Connecticut's Good Samaritan Laws and identify effective policy options. Harm Reduct J 2024; 21:124. [PMID: 38937759 PMCID: PMC11210010 DOI: 10.1186/s12954-024-00990-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/22/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Good Samaritan Laws are a harm reduction policy intended to facilitate a reduction in fatal opioid overdoses by enabling bystanders, first responders, and health care providers to assist individuals experiencing an overdose without facing civil or criminal liability. However, Good Samaritan Laws may not be reaching their full impact in many communities due to a lack of knowledge of protections under these laws, distrust in law enforcement, and fear of legal consequences among potential bystanders. The purpose of this study was to develop a systems-level understanding of the factors influencing bystander responses to opioid overdose in the context of Connecticut's Good Samaritan Laws and identify high-leverage policies for improving opioid-related outcomes and implementation of these laws in Connecticut (CT). METHODS We conducted six group model building (GMB) workshops that engaged a diverse set of participants with medical and community expertise and lived bystander experience. Through an iterative, stakeholder-engaged process, we developed, refined, and validated a qualitative system dynamics (SD) model in the form of a causal loop diagram (CLD). RESULTS Our resulting qualitative SD model captures our GMB participants' collective understanding of the dynamics driving bystander behavior and other factors influencing the effectiveness of Good Samaritan Laws in the state of CT. In this model, we identified seven balancing (B) and eight reinforcing (R) feedback loops within four narrative domains: Narrative 1 - Overdose, Calling 911, and First Responder Burnout; Narrative 2 - Naloxone Use, Acceptability, and Linking Patients to Services; Narrative 3 - Drug Arrests, Belief in Good Samaritan Laws, and Community Trust in Police; and Narrative 4 - Bystander Naloxone Use, Community Participation in Harm Reduction, and Cultural Change Towards Carrying Naloxone. CONCLUSIONS Our qualitative SD model brings a nuanced systems perspective to the literature on bystander behavior in the context of Good Samaritan Laws. Our model, grounded in local knowledge and experience, shows how the hypothesized non-linear interdependencies of the social, structural, and policy determinants of bystander behavior collectively form endogenous feedback loops that can be leveraged to design policies to advance and sustain systems change.
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Affiliation(s)
- Rachel L Thompson
- Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA
| | - Nasim S Sabounchi
- Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA
- Department of Health Policy and Management, City University of New York Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA
| | - Syed Shayan Ali
- University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
- Center for Interdisciplinary Research on AIDS at Yale, 135 College St., Suite 200, New Haven, CT, 06520, USA
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 065108, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
| | - Rebekah Heckmann
- Department of Emergency Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 065108, USA.
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Naumann J, Benson J, Lamberson M, Hunt S, Moran W, Stevens MW, Wolfson D. At-risk patient documentation and naloxone dispersal for a rural statewide EMS "Naloxone Leave Behind" program. J Am Coll Emerg Physicians Open 2024; 5:e13186. [PMID: 38766594 PMCID: PMC11099750 DOI: 10.1002/emp2.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/21/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
Objectives For successful Naloxone Leave Behind (NLB) programs, Emergency Medical Services (EMS) must identify patients at-risk for opioid overdose. We describe the first year of Vermont's NLB program and report rates of EMS documentation of at-risk patients with subsequent distribution of NLB kits in the subgroup of those refusing transport to an emergency department (ED). Methods This retrospective cohort review of all EMS encounters over 1 year compared on-scene EMS documented to retrospective chart reviewidentified at-risk patients eligible for NLB kit dispersal. EMS was educated to identify at-risk patients through statewide mandatory training modules. At-risk patients were identified by electronic chart review using the same training criteria. As per protocol, patients identified as at-risk by EMS who refuse ED transport are eligible for NLB. NLB-appropriate patients by retrospective chart review without NLB protocol use documentation by EMS were considered "missed." Results Of 110,701 EMS encounters, 2507 (2.4%) were at-risk by chart review. Among these, 793 refused transport to an ED. In this chart-review at-risk non-transported group, EMS documented 407 (51.3%) patients as at-risk by documenting use of the NLB protocol. Of these 407, EMS provided 141 (34.6%) with NLB kits. Fifteen (3.7%) patients refused kits. There were 386 (48.7%) potentially "missed" opportunities for NLB dispersal. Conclusion EMS documented 51.3% of patients eligible for NLB dispersal, with 34.6% receiving kits. There was no documentation for 48.7% of chart-review at-risk patients, suggesting "missed" distribution opportunities. This study highlights the need for improved EMS identification of at-risk patients, EMS documentation adherence, and NLB kit provision.
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Affiliation(s)
- Jesse Naumann
- Department of Emergency MedicineLarner College of Medicine, University of VermontBurlingtonVermontUSA
| | - Jamie Benson
- Department of RadiologyUniversity of VermontBurlingtonVermontUSA
- Division of Acute Care SurgeryDepartment of SurgeryUniversity of VermontBurlingtonVermontUSA
| | - Miles Lamberson
- Department of Emergency MedicineLarner College of Medicine, University of VermontBurlingtonVermontUSA
| | - Samantha Hunt
- Department of Emergency MedicineLarner College of Medicine, University of VermontBurlingtonVermontUSA
- Department of Emergency MedicineDartmouth HealthBurlingtonVermontUSA
| | - William Moran
- Division of Emergency PreparednessResponse, and Injury PreventionVermont Department of HealthBurlingtonVermontUSA
| | - Martha W. Stevens
- Department of Emergency MedicineLarner College of Medicine, University of VermontBurlingtonVermontUSA
| | - Daniel Wolfson
- Department of Emergency MedicineLarner College of Medicine, University of VermontBurlingtonVermontUSA
- Division of Emergency PreparednessResponse, and Injury PreventionVermont Department of HealthBurlingtonVermontUSA
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5
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Friedman NMG, Bivens MJ. Expanding access to substance misuse services through emergency medical services: envisioning a novel partnership for addiction medicine clinicians. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:8-11. [PMID: 38212992 DOI: 10.1080/00952990.2023.2286585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/18/2023] [Indexed: 01/13/2024]
Abstract
Emergency medical services (EMS) can be an invaluable ally of addiction medicine clinicians, but the potential role of EMS in combating the opioid epidemic has been under-realized. EMS has historically focused on emergency response and resuscitation in cases of overdose; however, EMS is also well-positioned to build rapport with persons who use drugs (PWUD), provide harm reduction services, and connect PWUD with additional treatment services and resources. A select number of EMS organizations have begun to offer substance-related programming that extends beyond resuscitation, but these offerings remain limited in scope and impact. This perspective argues that addiction medicine clinicians can bolster the ability of EMS to provide high quality substance-related services by engaging in prehospital care education, program development and research, and clinical care. This perspective shares practical strategies for addiction medicine clinicians to partner with EMS and considers several potential barriers that must be overcome, including bureaucratic challenges, variability in the scope of practice of EMS providers across different locations, and limited funding.
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Affiliation(s)
| | - Matthew J Bivens
- Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Friedman NMG, Molina CA, Glenn MJ. Harm reduction and emergency medical services: Opportunities for evidence-based programming. Am J Emerg Med 2023; 72:85-87. [PMID: 37499554 DOI: 10.1016/j.ajem.2023.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/12/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
Overdose fatalities are increasingly attributed to synthetic opioids, including fentanyl, which may be added to samples of illicit substances unknowingly to the user. As recently as April 2023, the Centers for Disease Control and Prevention has also raised awareness of the risks of xylazine, an animal tranquilizer that has been found in adulterated samples of illicit substance. A growing body of evidence supports the use of drug testing services, including fentanyl and xylazine test strips, to reduce the risks associated with substance use and prevent fatal overdoses. Emergency medical services clinicians serve on the frontline of the opioid epidemic and are uniquely positioned to distribute harm reduction materials. In this article, we advocate for emergency medical services to distribute fentanyl and xylazine test strips. We also critically evaluate legal and other barriers to implementation.
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Affiliation(s)
- Nicholas M G Friedman
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, United States of America.
| | - Caitlin A Molina
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, 1100 Glendon Ave., Suite 850, Los Angeles, CA 90024, United States of America.
| | - Melody J Glenn
- Departments of Emergency Medicine and Psychiatry, University of Arizona College of Medicine, 1501 N. Campbell Ave. AHSL 4161 E, Tucson, AZ 85724, United States of America.
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Liu A, Nelson AR, Shapiro M, Boyd J, Whitmore G, Joseph D, Cone DC, Couturier K. Prehospital Naloxone Administration Patterns during the Era of Synthetic Opioids. PREHOSP EMERG CARE 2023; 28:398-404. [PMID: 36854037 DOI: 10.1080/10903127.2023.2184886] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 03/02/2023]
Abstract
Background: The opioid epidemic is an ongoing public health emergency, exacerbated in recent years by the introduction and rising prevalence of synthetic opioids. The National EMS Scope of Practice Model was changed in 2017 to recommend allowing basic life support (BLS) clinicians to administer intranasal (IN) naloxone. This study examines local IN naloxone administration rates for 4 years after the new recommendation, and Glasgow Coma Scale (GCS) scores and respiratory rates before and after naloxone administration.Methods: This retrospective cohort study evaluated naloxone administrations between April 1st 2017 and March 31st 2021 in a mixed urban-suburban EMS system. Naloxone dosages, routes of administration, and frequency of administrations were captured along with demographic information. Analysis of change in the ratio of IN to intravenous (IV) naloxone administrations per patient was performed, with the intention of capturing administration patterns in the area. Analyses were performed for change over time of IN naloxone rates of administration, change in respiratory rates, and change in GCS scores after antidote administration. ALS and BLS clinician certification levels were also identified. Bootstrapping procedures were used to estimate 95% confidence intervals for correlation coefficients.Results: Two thousand and ninety patients were analyzed. There was no statistically significant change in the IN/parenteral ratio over time (p = 0.79). Repeat dosing increased over time from 1.2 ± 0.4 administrations per patient to 1.3 ± 0.5 administrations per patient (r = 0.078, 95% CI: 0.036 - 0.120; p = 0.036). Mean respiratory rates before (mean = 12.6 - 12.6, r = -0.04, 95% CI: -0.09 - 0.01; p = 0.1) and after (mean = 15.2 - 14.9, r = -0.03, 95% CI: -0.08 - 0.01; p = 0.172) naloxone administration have not changed. While initial GCS scores have become significantly lower, GCS scores after administration of naloxone have not changed (initial median GCS 10 - 6, p < 0.001; final median GCS 15 - 15, p = 0.23).Conclusions: Current dosing protocols of naloxone appear effective in the era of synthetic opioids in our region, although patients may be marginally more likely to require repeat naloxone doses.
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Affiliation(s)
- Andrew Liu
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Alexander R Nelson
- Yale Department of Emergency Medicine, EMS Section, New Haven, Connecticut
| | - Matthew Shapiro
- Yale Department of Emergency Medicine, EMS Section, New Haven, Connecticut
| | - Jeffrey Boyd
- American Medical Response, New Haven, Connecticut
| | | | - Daniel Joseph
- Yale Department of Emergency Medicine, EMS Section, New Haven, Connecticut
| | - David C Cone
- Yale Department of Emergency Medicine, EMS Section, New Haven, Connecticut
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Ray B, Richardson NJ, Attaway PR, Smiley-McDonald HM, Davidson P, Kral AH. A national survey of law enforcement post-overdose response efforts. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:199-205. [PMID: 36820614 DOI: 10.1080/00952990.2023.2169615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Background: Law enforcement agencies in the US have provided naloxone to officers and developed initiatives to follow-up after a non-fatal overdose. However, the prevalence and characteristics of these efforts have yet to be documented in research literature.Objectives: We sought to understand the national prevalence of naloxone provision among law enforcement and examine the implementation of post-overdose follow-up.Methods: We administered a survey on drug overdose response initiatives using a multimodal approach (online and mail) to a nationally representative sample of law enforcement agencies (N = 2,009; 50.1% response rate) drawn from the National Directory of Law Enforcement Administrators database. We further examine a subsample of agencies (N = 1,514) that equipped officers with naloxone who were also asked about post-overdose follow-up.Results: We found 81.7% of agencies reported officers were equipped with naloxone; among these, approximately one-third (30.3%) reported follow-up after an overdose. More than half (56.8%) of agencies indicated partnership in follow-up with emergency medical services as the most common partner (68.8%). There were 21.4% of agencies with a Quick Response Team, a popular national post-overdose model, and were more likely to indicate partnership with a substance use disorder treatment provider than when agencies were asked generally about partners in follow-up (74.5% and 26.2% respectively).Conclusion: Many law enforcement agencies across the US have equipped officers with naloxone, and about one-third of those are conducting follow-up to non-fatal overdose events. Post-overdose follow-up models and practices vary in ways that can influence treatment engagement and minimize harms against persons who use drugs.
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Affiliation(s)
- Bradley Ray
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | - Pete Davidson
- Department of Medicine, Division Global Public Health, University of California, San Diego, CA, USA
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9
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Post-overdose follow-up in the community with peer recovery specialists: the Lake Superior Diversion and Substance Use Response Team. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100139. [PMID: 36994366 PMCID: PMC10040321 DOI: 10.1016/j.dadr.2023.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/03/2023]
Abstract
Background As the overdose epidemic continues to worsen, nonfatal overdose calls for service represent a critical touchpoint for intervention. While most studies have focused on law enforcement led post-overdose follow-up, the current study describes the programmatic characteristics and outcomes of a non-law enforcement post overdose program comprised of peer specialists embedded within a local police department. Methods We examined information on 341 follow-up responses occurring over a 16-month study period using administrative data. We assessed programmatic characteristics including demographic information on clients, referral source, engagement type, and goal completion. Results The results indicate that over 60% of client referrals ended in the goal of in-person contact. Of those, about 80% went on to complete an engagement goal with the peer specialist. We found no significant variation in client demographics and referral source or follow-up engagement (in-person or not); however, client referrals from law enforcement first responders, the most common source, are significantly less likely to result in an in-person contact, though, if contact is made, similarly likely to complete an engagement goal. Conclusions Post overdose response programs that do not involve law enforcement are exceedingly rare. Given that some research has shown that police involvement in post overdose response can have unexpected, associated harms, it is important to assess the effectiveness of post overdose programs that do not involve the police. Findings here suggest that this type of program is successful at locating and engaging community members into recovery support services who have experienced an overdose.
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10
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LeSaint K, Montoy JC, Silverman E, Raven M, Schow S, Coffin P, Brown J, Mercer M. Implementation of a Leave-behind Naloxone Program in San Francisco: A One-year Experience. West J Emerg Med 2022; 23:952-957. [DOI: 10.5811/westjem.2022.8.56561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: In response to the ongoing opioid overdose crisis, US officials urged the expansion of access to naloxone for opioid overdose reversal. Since then, emergency medical services’ (EMS) dispensing of naloxone kits has become an emerging harm reduction strategy.
Methods: We created a naloxone training and low-barrier distribution program in San Francisco: Project FRIEND (First Responder Increased Education and Naloxone Distribution). The team assembled an advisory committee of stakeholders and subject-matter experts, worked with local and state EMS agencies to augment existing protocols, created training curricula, and developed a naloxone-distribution data collection system. Naloxone kits were labeled for registration and data tracking. Emergency medical technicians and paramedics were asked to distribute naloxone kits to any individuals (patient or bystander) they deemed at risk of experiencing or witnessing an opioid overdose, and to voluntarily register those kits.
Results: Training modalities included a video module (distributed to over 700 EMS personnel) and voluntary, in-person training sessions, attended by 224 EMS personnel. From September 25, 2019–September 24, 2020, 1,200 naloxone kits were distributed to EMS companies. Of these, 232 kits (19%) were registered by EMS personnel. Among registered kits, 146 (63%) were distributed during encounters for suspected overdose, and 103 (44%) were distributed to patients themselves. Most patients were male (n = 153, 66%) and of White race (n = 124, 53%); median age was 37.5 years (interquartile range 31-47).
Conclusion: We describe a successful implementation and highlight the feasibility of a low-threshold, leave-behind naloxone program. Collaboration with multiple entities was a key component of the program’s success.
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Affiliation(s)
- Kathy LeSaint
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Juan Carlos Montoy
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Eric Silverman
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Maria Raven
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Samuel Schow
- San Francisco Fire Department, San Francisco, California
| | - Phillip Coffin
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California; San Francisco Department of Public Health, San Francisco, California
| | - John Brown
- San Francisco Department of Public Health, San Francisco, California
| | - Mary Mercer
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
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Wightman RS, Nelson LS. Naloxone Dosing in the Era of Fentanyl: The Path Widens by Traveling Down It. Ann Emerg Med 2022; 80:127-129. [DOI: 10.1016/j.annemergmed.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Indexed: 11/01/2022]
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12
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Auty SG, Griffith KN. Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States. Drug Alcohol Depend 2022; 232:109340. [PMID: 35131533 PMCID: PMC8809643 DOI: 10.1016/j.drugalcdep.2022.109340] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic caused disruptions in the delivery of health services, which may have adversely affected access to substance use disorder (SUD) treatment services. Medicaid expansion has been previously associated with increased access to SUD services for low-income adults. Thus, the pandemic may have differentially impacted overdose mortality depending on expansion status. This study examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020. METHODS State-level data on overdose mortality were obtained from the Centers for Disease Control and Prevention's WONDER database for 2013-2020 (N = 408 state-years). The primary outcomes were drug and opioid overdose deaths per 100,000 residents. The primary exposure was Medicaid expansion status as of January 1st, 2020. Difference-in-difference (DID) models were used to compare changes in outcomes between expansion and non-expansion states after the onset of the COVID-19 pandemic. RESULTS The U.S. experienced 91,799 drug overdose deaths in 2020, a 29.9% relative increase from 2019. Expansion states experienced an adjusted increase of 7.0 drug overdose deaths per 100,000 residents (95% CI 3.3, 10.7) and non-expansion states experienced an increase of 4.3 deaths (95% CI 1.5, 8.2) from 2019 to 2020. Similar trends were observed in opioid overdose deaths. In DID models, Medicaid expansion was not associated with changes in drug (0.9 deaths, 95% CI -2.0, 3.7) or opioid overdose deaths (0.8 deaths, 95% CI -1.8, 3.5). CONCLUSIONS The increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.
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Affiliation(s)
- Samantha G. Auty
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118, USA,Correspondence to: 715 Albany Street, Talbot Building, Boston, Massachusetts 02118, USA
| | - Kevin N. Griffith
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Avenue, Nashville, Tennessee 37203, USA,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130, USA
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13
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Smiley-McDonald HM, Attaway PR, Richardson NJ, Davidson PJ, Kral AH. Perspectives from law enforcement officers who respond to overdose calls for service and administer naloxone. HEALTH & JUSTICE 2022; 10:9. [PMID: 35212812 PMCID: PMC8874742 DOI: 10.1186/s40352-022-00172-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/02/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Many law enforcement agencies across the United States equip their officers with the life-saving drug naloxone to reverse the effects of an opioid overdose. Although officers can be effectively trained to administer naloxone, and hundreds of law enforcement agencies carry naloxone to reverse overdoses, little is known about what happens on scene during an overdose call for service from an officer's perspective, including what officers perceive their duties and responsibilities to be as the incident evolves. METHODS The qualitative study examined officers' experiences with overdose response, their perceived roles, and what happens on scene before, during, and after an overdose incident. In-person interviews were conducted with 17 officers in four diverse law enforcement agencies in the United States between January and May 2020. RESULTS Following an overdose, the officers described that overdose victims are required to go to a hospital or they are taken to jail. Officers also described their duties on scene during and after naloxone administration, including searching the belongings of the person who overdosed and seizing any drug paraphernalia. CONCLUSION These findings point to a pressing need for rethinking standard operating procedures for law enforcement in these situations so that the intentions of Good Samaritan Laws are upheld and people get the assistance they need without being deterred from asking for future help.
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Affiliation(s)
- Hope M Smiley-McDonald
- Division for Applied Justice Research, RTI International, Research Triangle Park, North Carolina, USA.
| | - Peyton R Attaway
- Division for Applied Justice Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Nicholas J Richardson
- Division for Applied Justice Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Peter J Davidson
- Department of Medicine, Division Global Public Health, University of California, San Diego, La Jolla, California, USA
| | - Alex H Kral
- Community Health Research Division, RTI International, Berkeley, California, USA
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14
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Emergency medicine services providers' attitudes toward naloxone distribution and training programs. Am J Emerg Med 2021; 51:76-78. [PMID: 34688204 DOI: 10.1016/j.ajem.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
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15
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Bennett AS, Elliott L. Naloxone's role in the national opioid crisis-past struggles, current efforts, and future opportunities. Transl Res 2021; 234:43-57. [PMID: 33684591 PMCID: PMC8327685 DOI: 10.1016/j.trsl.2021.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023]
Abstract
Over the past 25 years, naloxone has emerged as a critical lifesaving overdose antidote. Public health advocates and community activists established early methods for naloxone distribution to people who inject drugs, but a legacy of stigmatization and opposition to universal naloxone access continues to limit the drug's full potential to reduce opioid-related mortality. The establishment of naloxone distribution programs under the umbrella of syringe exchange programs faces the same practical, ideological and financial barriers to expansion similar to those faced by syringe exchange programs themselves. The expansion of naloxone from the confines of a few syringe exchange programs to what we see today represents an enormous triumph for the grass-roots activists, service providers, and public health professionals who have fought to guarantee lay access to naloxone. Despite the extensive efforts to expand access to naloxone, naloxone continues to remains a scarce resource in many US localities. Considerable naloxone "deserts" remain and even where there is naloxone access, it does not always reach those at risk. Promising areas for expansion include the development of more robust telehealth methods for naloxone distribution, including subsidized mail delivery programs; lowering barriers to pharmacy access; working with hospitals, ambulances, and law enforcement to expand naloxone "leave behind" programs; providing naloxone co-prescription with medications for opioid use disorder; and working with prisons, shelters, and networks of people who use drugs to increase access to the lifesaving medication. Efforts to ensure over-the-counter and low- or no-cost naloxone are ongoing and stand alongside medication-assisted treatments as efficacious, readily-actionable, and cost-efficient population-level interventions available for combatting opioid-related overdose in the United States.
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Affiliation(s)
- Alex S Bennett
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York; Center for Drug Use and HIV Research (CDUHR), College of Global Public Health, New York University, New York, New York.
| | - Luther Elliott
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York; Center for Drug Use and HIV Research (CDUHR), College of Global Public Health, New York University, New York, New York
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16
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Zozula A, Neth MR, Hogan AN, Stolz U, McMullan J. Non-transport after Prehospital Naloxone Administration Is Associated with Higher Risk of Subsequent Non-fatal Overdose. PREHOSP EMERG CARE 2021; 26:272-279. [PMID: 33535012 DOI: 10.1080/10903127.2021.1884324] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: U.S. opioid overdoses increased nearly sixfold from 1999 to 2018, and greater than 1% of all emergency medical services (EMS) encounters now involve naloxone administration. While "treat and release" protocols may have low short-term mortality, the risk of subsequent non-fatal overdoses is not known. This study compares the risk of repeat overdose encounters between patients transported to an emergency department (ED) and those who refused transport after prehospital naloxone administration. Methods: All EMS charts within a large single-tier fire-based urban EMS system between January 1 and August 31, 2018 were reviewed if either naloxone administration or a clinical impression related to opioid overdose was documented. Charts were excluded if there was no documented evidence of an opioid toxidrome (respiratory depression or altered mental status), if there was another clear explanation for the symptoms (e.g., hypoglycemia), or if naloxone was not administered. Ten percent of charts were reviewed by a second author to assess reliability. Cox regression (survival analysis) was used to estimate the risk of a subsequent EMS encounter with naloxone administration following an index encounter with naloxone administration. Results: Of the 2143 charts reviewed, 1311 unique patients with 1600 overdose encounters involving naloxone administration were identified. Inter-rater reliability for chart inclusion was strong [κ = 0.83 (95% CI: 0.72-0.90)]. Police/bystanders administered naloxone in 208/1600 (13.0%) encounters. A substantial proportion of encounters resulted in transport refusal (674/1600, 42.1%). The final Cox model included only refusal vs. acceptance of transport to an ED during the index EMS encounter. Patient age, gender, and naloxone administration prior to EMS arrival were not statistically significant in univariate or multivariable analyses, nor were they significant confounders. Refusal of transport was associated with a hazard ratio of 1.66 (95% CI: 1.23-2.23) for subsequent EMS encounters with naloxone administration. Conclusions: Non-transport after prehospital naloxone administration is associated with an increased risk of subsequent non-fatal overdose requiring EMS intervention. Limitations include the use of a single EMS agency as patients may have had uncaptured overdose encounters in neighboring municipalities.
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Affiliation(s)
- Alexander Zozula
- Department of Emergency Medicine, Division of Prehospital and Disaster Medicine, UMMS-Baystate, Springfield, MA (AZ);; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR (MRN);; Department of Emergency Medicine, Division of EMS, University of Texas Southwestern Medical Center, Dallas, TX (ANH);; Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH (US);; Department of Emergency Medicine, Division of EMS, University of Cincinnati, Cincinnati, OH (JM)
| | - Matthew R Neth
- Department of Emergency Medicine, Division of Prehospital and Disaster Medicine, UMMS-Baystate, Springfield, MA (AZ);; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR (MRN);; Department of Emergency Medicine, Division of EMS, University of Texas Southwestern Medical Center, Dallas, TX (ANH);; Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH (US);; Department of Emergency Medicine, Division of EMS, University of Cincinnati, Cincinnati, OH (JM)
| | - Andrew N Hogan
- Department of Emergency Medicine, Division of Prehospital and Disaster Medicine, UMMS-Baystate, Springfield, MA (AZ);; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR (MRN);; Department of Emergency Medicine, Division of EMS, University of Texas Southwestern Medical Center, Dallas, TX (ANH);; Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH (US);; Department of Emergency Medicine, Division of EMS, University of Cincinnati, Cincinnati, OH (JM)
| | - Uwe Stolz
- Department of Emergency Medicine, Division of Prehospital and Disaster Medicine, UMMS-Baystate, Springfield, MA (AZ);; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR (MRN);; Department of Emergency Medicine, Division of EMS, University of Texas Southwestern Medical Center, Dallas, TX (ANH);; Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH (US);; Department of Emergency Medicine, Division of EMS, University of Cincinnati, Cincinnati, OH (JM)
| | - Jason McMullan
- Department of Emergency Medicine, Division of Prehospital and Disaster Medicine, UMMS-Baystate, Springfield, MA (AZ);; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR (MRN);; Department of Emergency Medicine, Division of EMS, University of Texas Southwestern Medical Center, Dallas, TX (ANH);; Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH (US);; Department of Emergency Medicine, Division of EMS, University of Cincinnati, Cincinnati, OH (JM)
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