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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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Freiermuth CE, Ancona RM, Brown JL, Punches BE, Ryan SA, Ingram T, Lyons MS. Evaluation of a large-scale health department naloxone distribution program: Per capita naloxone distribution and overdose morality. PLoS One 2023; 18:e0289959. [PMID: 37566565 PMCID: PMC10420337 DOI: 10.1371/journal.pone.0289959] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES To report per-capita distribution of take-home naloxone to lay bystanders and evaluate changes in opioid overdose mortality in the county over time. METHODS Hamilton County Public Health in southwestern Ohio led the program from Oct 2017-Dec 2019. Analyses included all cartons distributed within Hamilton County or in surrounding counties to people who reported a home address within Hamilton County. Per capita distribution was estimated using publicly available census data. Opioid overdose mortality was compared between the period before (Oct 2015-Sep 2017) and during (Oct 2017-Sep 2019) the program. RESULTS A total of 10,416 cartons were included for analyses, with a total per capita distribution of 1,275 cartons per 100,000 county residents (average annual rate of 588/100,000). Median monthly opioid overdose mortality in the two years before (28 persons, 95% CI 25-31) and during (26, 95% CI 23-28) the program did not differ significantly. CONCLUSIONS Massive and rapid naloxone distribution to lay bystanders is feasible. Even large-scale take-home naloxone distribution may not substantially reduce opioid overdose mortality rates.
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Affiliation(s)
- Caroline E. Freiermuth
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Rachel M. Ancona
- Department of Emergency Medicine, Washington University, St Louis, Missouri, United States of America
| | - Jennifer L. Brown
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - Brittany E. Punches
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Shawn A. Ryan
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Brightview Health LLC, Cincinnati, Ohio, United States of America
| | - Tim Ingram
- Hamilton County Public Health, Cincinnati, Ohio, United States of America
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Michael S. Lyons
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
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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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