Opioid overdose history and awareness of naloxone in patients seeking outpatient detoxification

Saurabh B. Bhardwaj, MD; Gerald Cochran, PhD; Julie Kmiec, DO

doi:10.5055/jom.2019.0508

Authors

Saurabh B. Bhardwaj, MD
Gerald Cochran, PhD
Julie Kmiec, DO

DOI:

https://doi.org/10.5055/jom.2019.0508

Keywords:

overdose education, naloxone distribution, detoxification, opioid overdose

Abstract

Objectives: The goal of this study was to investigate whether patients were knowledgeable about naloxone, and whether they would accept overdose (OD) education and naloxone distribution (OEND), if available.

Design: This is a cross-sectional study to ascertain participants knowledge about OEND. A questionnaire was designed requesting information regarding age, gender, ethnicity, previous OD experience, type of substance(s) used, availability and use of naloxone for reversal, other treatment interventions utilized if witnessed OD, ways of seeking help for OD, knowledge about OEND, and willingness to accept OEND.

Setting: Study was conducted at the ambulatory detoxification clinic of a tertiary healthcare institution.

Participants: Consecutive 131 patients, who presented for primary treatment of opioid detoxification during their visits to the ambulatory detoxification clinic between a predefined timeline from October 2014 through February 2015, were invited to participate, and all 131 agreed to be included in the study. A total of 124 participants returned completed questionnaires (95 percent response rate.)

Results: Overall, 68 (52 percent) of the participants indicated that they would accept OEND. A logistic regression analysis showed that younger participants (95% CI: 0.9-1, p = 0.02) and those who identified as non-white (95% CI: 0-0.8, p = 0.01) had higher odds for accepting OEND. Furthermore, prior administration of naloxone was significantly associated with OEND acceptance (95% CI: 1.6-68.6, p = 0.01).

Conclusions: Results indicate more than half of participants presenting for outpatient detoxification from opioids have had an OD or witnessed an OD. More than half of the participants were willing to accept OEND. This study provides evidence that patients starting their recovery are willing to accept naloxone.

Author Biographies

Saurabh B. Bhardwaj, MD

Assistant Professor of Psychiatry, Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi

Gerald Cochran, PhD

Associate Professor, Department of Internal Medicine, University of Utah, Salt Lake City, Utah

Julie Kmiec, DO

Assistant Professor of Psychiatry, Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

References

Darke S, Hall W: Heroin overdose: Research and evidence-based intervention. J Urban Health. 2003; 80(2): 189-200.

Ashton H, Hassan Z: Best evidence topic report. Intranasal naloxone in suspected opioid overdose. Emerg Med J. 2006; 23(3): 221-223.

Wheeler E, Jones TS, Gilbert MK, et al.: Opioid overdose prevention programs providing naloxone to laypersons – United States, 2014. MMWR Morb Mortal Wkly Rep. 2015; 64(23): 631-635.

Seal KH, Downing M, Kral AH, et al.: Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: A survey of street-recruited injectors in the San Francisco Bay Area. J Urban Health. 2003; 80(2): 291-301.

Lagu T, Anderson BJ, Stein M: Overdoses among friends: Drug users are willing to administer naloxone to others. J Subst Abuse Treat. 2006; 30(2): 129-133.

Binswanger IA, Koester S, Mueller SR, et al.: Overdose education and naloxone for patients prescribed opioids in primary care: A qualitative study of primary care staff. J Gen Intern Med. 2015; 30(12): 1837-1844.

Green TC, Bowman SE, Zaller ND, et al.: Barriers to medical provider support for prescription naloxone as overdose antidote for lay responders. Subst Use Misuse. 2013; 48(7): 558-567.

Green TC, Case P, Fiske H, et al.: Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states. J Am Pharm Assoc (2003). 2017; 57(2S): S19-S27.e4.

Nielsen S, Peacock A, Lintzeris N, et al.: Knowledge of opioid overdose and attitudes to supply of take-home naloxone among people with chronic noncancer pain prescribed opioids. Pain Med. 2017; 19: 533-540.

Bailey GL, Herman DS, Stein MD: Perceived relapse risk and desire for medication assisted treatment among persons seeking inpatient opiate detoxification. J Subst Abuse Treat. 2013; 45(3): 302-305.

Wines JD Jr, Saitz R, Horton NJ, et al.: Overdose after detoxification: A prospective study. Drug Alcohol Depend. 2007; 89(2-3): 161-169.

Britton PC, Wines JD Jr, Conner KR: Non-fatal overdose in the 12 months following treatment for substance use disorders. Drug Alcohol Depend. 2010; 107(1): 51-55.

Darke S, Marel C, Mills KL, et al.: Patterns and correlates of non-fatal heroin overdose at 11-year follow-up: Findings from the Australian Treatment Outcome Study. Drug Alcohol Depend. 2014; 144: 148-152.

Kirane H, Ketteringham M, Bereket S, et al.: Awareness and attitudes toward intranasal naloxone rescue for opioid overdose prevention. J Subst Abuse Treat. 2016; 69: 44-49.

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; 103(6): 979-989.

Behar E, Rowe C, Santos GM, et al.: Acceptability of naloxone co-prescription among primary care providers treating patients on long-term opioid therapy for pain. J Gen Intern Med. 2017; 32: 291-295.

Kestler A, Buxton J, Meckling G, et al.: Factors associated with participation in an emergency department-based take-home naloxone program for at-risk opioid users. Ann Emerg Med. 2017; 69: 340-346.