Training Bystanders to Spot Opioid Overdose Saves Lives

Deborah Brauser

February 05, 2013

Educating and training potential bystanders to recognize opioid overdose may reduce deaths, new research suggests.

In the study, almost 3000 potential bystanders in Massachusetts underwent state-supported overdose education and nasal naloxone distribution (OEND) programs.

Results showed that these individuals participated in 327 rescue attempts. In addition, communities with OEND programs had adjusted death rates from opioid overdoses that were significantly lower than communities without the programs.

"This study provides observational evidence that by training potential bystanders to prevent, recognize, and respond to opioid overdoses, OEND is an effective intervention," write Alexander Y. Walley, MD, assistant professor of medicine at Boston University School of Medicine in Massachusetts and from the Section of General Internal Medicine at Boston Medical Center, and colleagues.

"Because OEND targets not only the overdose risk behaviours of the trainee but empowers trainees to intervene in another person's overdose, it makes a fuller impact at the community level," they add.

The study was published online January 31 in BMJ.

Leading Cause of Death

"Poisoning, nine out of 10 of which are related to drug overdoses, has surpassed motor vehicle crashes to be the leading cause of death by injury in the United States," report the investigators.

For this study, they assessed participation in OEND programs, which were implemented in 19 communities in Massachusetts in which at least 5 opioid overdose–related fatalities were reported in 2004, 2005, and 2006.

The 10- to 60-minute programs were aimed at "opioid users at risk for overdose, social service agency staff, family, and friends of opioid users."

All 2912 participants (mean age, 38.1 years) were trained between 2006 and 2009 to recognize and respond to an overdose by notifying emergency personnel, providing rescue breathing, and delivering nasal naloxone (an opioid antagonist) from provided rescue kits.

Before receiving an additional naloxone kit, each participant had to fill out a questionnaire regarding their rescue attempts.

Death rates from opioid-related overdoses were determined by examining data from the Massachusetts Registry of Vital Records and Statistics. Hospitalizations were determined by assessing state inpatient and emergency department (ED) outpatient discharge databases.

Results showed that of the 327 rescue attempts reported, 87% were by opioid users. In other cases, the rescuer was usually friends with the person who overdosed.

Full information was available for 153 rescue attempts — 150 of which involved the successful use of naloxone (98%). Of the other 3, those who overdosed survived after receiving ED care.

Broader Implementation Needed?

Both community-year strata with 1 to 100 enrollments per 100,000 population and more than 100 enrollments per 100,000 population showed significantly reduced adjusted death rate ratios compared with communities without the programs (0.73; 95% confidence interval [CI], 0.57 - 0.91 and 0.54; 95% CI, 0.39 - 0.76, respectively; for both, P < .01).

In other words, both low and high implementation of the programs were associated with lower death rates "when adjusted for demographics, utilization of addiction treatment, and doctor shopping."

There were no between-group differences in the rates of nonfatal opioid-related hospitalization. The researchers note that this may be because the program encourages bystanders to call upon the emergency medical system for help.

Overall, the findings show that "OEND is an effective public health intervention to address increasing mortality in the opioid overdose epidemic," write the investigators, noting that the program was also associated with a dose-related impact.

In addition, they report that similar programs in Massachusetts have enrolled heroin users, ED patients, jailed individuals, police officers, and firefighters.

"Two features of the Massachusetts OEND programs that supported broad implementation include the use of a nasal naloxone delivery device and the use of a standing order issued by the health department, which allowed non-medical personnel to deliver OEND," write the investigators.

"These features may enable broader implementation with greater impact as more communities implement OEND," they conclude.

The study was funded by a grant from the Centers for Disease Control and Prevention. The study authors have disclosed no other relevant financial relationships.

BMJ. Published online January 31, 2013. Full article

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